How It Happened

January 8, 2014 Here’s how it happened. My husband, Rick, started smoking when he was about 15, which would be 53 years ago. He quit last February. Now, the medics and public health people will tell you it’s never too late to quit smoking, and I will say that Rick was glad to finally get that monkey off his back. He enjoyed, especially, not having to spend money on the habit. He said that after he quit, the usual time would come to light up, and he’d think, “Oh, I don’t do that anymore.” So it’s never too late to quit, but sometimes, even when you quit, it’s too late to save your life. I did nag him to quit years ago. He reacted to nagging like most people do – he became annoyed. After a while I realized that my pushing him to quit would never make him quit, but it would hurt our relationship, so I stopped. At this point, the still small voice inside that never seems to stop its yapping says, “So it could have hurt your relationship. He might have lived longer.” Yeah, yeah, yeah. Stupid voice. So he smoked. In 1997 he was diagnosed with renal failure. Then he was diagnosed with prostate cancer. The growth of the cancer had blocked up his plumbing, and caused the renal failure. I had nagged him to go to the doctor, but he wouldn’t go. He had to work, and he figured he’d “work out” whatever the problem was. News flash for all you supermen (and women) out there. You can’t “work out” kidney failure or cancer like it’s a slight muscle spasm. He was only 52 when the prostate cancer was diagnosed. Because he was a Vietnam vet and a lot of guys exposed to Agent Orange in Vietnam came down with early prostate cancer, I had to wonder. He told me he’d been on the ship out in the Tonkin Gulf the whole time, picking up ditched jet pilots, so that couldn’t be it. The Veterans’ Administration agreed. He had surgery, was told he no longer had cancer, his kidneys regained enough function for him to carry on without dialysis, and he went on his way until 2009, when he was diagnosed with bladder cancer. Anyone want to guess what causes bladder cancer? Anyone? Yes! Smoking! Smoking causes bladder cancer because the irritants and carcinogens end up in the bladder as the kidneys clean toxins out of the body. Smoking doesn’t cause every bladder cancer, I’m sure. But it causes a lot of bladder cancer. Then his kidneys failed again, this time permanently. This condition is called “end stage renal failure.” Sounds pretty serious when you put it like that, and it is. That’s when you have to have dialysis, or a new kidney, in order to stay alive. Rick did dialysis for four years. About three years in his emphysema/COPD (caused by smoking) began to get worse. In the spring and early summer of 2013, Rick’s nurses and I began to notice a decline. He was no longer his snarky self, but more subdued. He was told his lungs had about 30% function left. Then he got pneumonia and peritonitis in June. He got better, and then he got pneumonia again in August. Then his father died, and after that he seemed to give up, and was bedridden. His lungs were filling with fluid, some of which was removed manually by his pulmonologist. How is fluid removed from a lung? You stick a tube in and let it drain. Try not to think about it too much. About this time we learned that his heart valves had become stiff and didn’t work very well any more. His pulse was high and his blood pressure low. A cardiologist told Rick that the surgery to fix the heart valves would leave him on a respirator for the rest of his life because of the poor condition of his lungs, and there was always the possibility that he might not survive surgery. One night in early December Rick couldn’t breathe and I called 911. He was airlifted to Seattle, taking a “kick ass” helicopter ride (his words). He loved seeing the Seattle wheel on the waterfront all lit up with colored lights. He was diagnosed with double pneumonia and put on heavy antibiotics. After a week in the hospital and having more fluid removed from his lungs, he came home and was better than he’d been since last summer. He got out of bed and cooked a few meals for himself. He even went into the living room to watch TV. He was with us for the opening of presents on Christmas morning, but then slept for the rest of the day. Two days after Christmas I awoke to the sound of him calling my name. “What?” I said. “Nine one one,” he gasped. I made the call. The EMTs came again, and hauled him out the door again. This time the boats were running, so he didn’t get a helicopter ride. I went and saw him in the hospital that morning, then went and had lunch with my cousin Nancy at noon, then went back to the hospital in the afternoon to see him again. His nephrologist came by to see him, and while he was there, Rick asked what the diagnosis was for his condition. The doctor said, “Multiple organ failure. First your kidneys, then your lungs, and now your heart is involved.” Rick and I agreed after the doctor left that, like “end stage renal failure,” “multiple organ failure” sounded pretty serious. When I left we smiled at each other. We kissed. We both said, “I love you.” It was a sweet and kind of sad good-bye, because we both knew Rick’s condition was serious. As I went out the door he was looking out the window at the view to the east, over the city rooftops to the Cascades. It was the last time I saw him conscious. We spoke on the phone several times the next day. He told me the thoracic surgeons wanted to put a shunt into his lung and let it drain “for many days.” They’d be doing the procedure that evening, around five. I fiddled around getting ready to go. Stopped to do some shopping for a few sundries on the way. Had an early dinner while listening to Prairie Home Companion on the radio. The last time I spoke with him on the phone, he said they were getting him prepared for the procedure. He told me the room number (he got it wrong), and said he’d be there and in Intermediate Care afterward. I got to the hospital, went to the right floor and asked for the wrong room, but the nurses knew who he was and where he was. I peeked in and could see him surrounded by people in scrubs. A nurse grabbed me and led me to the waiting room and said he’d come to get me when the procedure was over and I could go see Rick then. I was sitting in the waiting room playing Scrabble on my Kindle when the alarm went off. It was the loudest, ugliest, most annoying and disturbing alarm I’d ever heard in a hospital. I didn’t take it personally. For some reason I didn’t think it could be Rick, or if I did, I quickly stifled the possibility. No, that can’t be Rick. But then I saw a couple of the guys in the waiting room looking out the door and pointing and one said, “It’s that room right there.” That room right there was Rick’s. In a daze I began to gather my things. I spilled my water all over myself and didn’t pay it any attention as I kept gathering and went out of the waiting room and to the open space in front of the room where Rick was. There stood a crowd of hospital employees staring into the room, gaping in horror. I looked in and could see Rick’s face. There was blood all over his chin. I touched the arm of a woman who looked more senior than the others in the group, and said, “That’s my husband. What’s happening?” She looked at me with eyes of pity and said, “I’m so sorry.” At that point I don’t know how I got from where I was to the little room next to Rick’s room. I was pushed, or guided, or led, because boy, they really don’t want you watching what’s going on at any time but especially when something has gone wrong. So I’m blank on how I walked back toward the hallway and then was led into that little room, where there were upholstered chairs, like in a living room, and a lamp that shed a muted ambient light. A quiet room in which to hear bad news. A woman sat with me, and then a surgeon came in, determined that I was Mrs. Tuel, and said, “I’m very very sorry. His heart stopped.” I felt a raw jolt – what? But I didn’t get to say good-bye! I was going to see him afterward! I… I don’t remember much else that was said although I’m pretty sure that surgeon kept talking, until about fifteen minutes later when another surgeon came in and said, “We have a heartbeat, and blood pressure.” This after twenty-two minutes of CPR. The first surgeon was astonished. The second surgeon said that they expected to find blood in his lungs when they put the shunt in, but they didn’t expect him to throw up blood, which he did, foamy fresh blood. That’s why I saw blood running down his chin. Then both surgeons began to advise me that Rick had been tortured enough, and if his heart stopped again, we should “let him go.” That they would try to make him comfortable as they would any patient in his condition, but that it would be best not to try any more heroics to save him or bring him back. A chaplain was called. She was a sweet middle-aged lady who was very nice and informed me that I was in shock. She told me her name but I do not remember it. She stood by me when I went into Rick’s room. He was on a ventilator and was not conscious. He was never conscious again. I went to his side and held his hand and talked to him, telling him I loved him, thanking him for loving me. “And there it is,” the chaplain would say every time I said something to him. After a while the chaplain announced that she was going home. I envied her having the option to walk out of the hospital and back to her ordinary life for about a split second and then walked over to Rick’s bed, leaned in close to him and whispered, “I thought she’d never leave.” Listen, chaplains are good people who do heroic work, and I don’t think anyone could have said anything at all to me at that time that I would have liked. They moved him up one floor to the exact same room. The nurse heard me calling him Rick. Up until then everyone called him “Mark,” which was his legal name, and we had never fought that. He just answered to Mark. But at this point, the nurse wrote on the white board, “Prefers to be called Rick,” and all the nurses called him Rick the rest of the time he was there. I stayed by his side. I sang to him. I sang “Madeline,” a song he wrote about a girl he met while on tour in 1970. I got the words mixed up. I sang, “How Can I Keep from Singing,” and “Blackbird,” and “All Through the Night.” I sang, and talked to him. I read to him from a magazine I had brought along for him. Our sons, J.D. and Drew came, and they both spoke to their dad, told him they loved him, touched his face, and said good-bye. They went and got Marley the dog out of my car in the garage and took her back home to the island. After the guys left the nurse brought a cot in, and I was able to lie down if not sleep that night. When I heard one nurse tell another not to turn an overhead light on because his wife was sleeping, I spoke up and said, “I’m not asleep.” I dozed, and woke, and watched nurses come in to turn Rick and adjust his equipment. His arms were in restraints to keep him from pulling the ventilator tube out. I hated that. In the morning the head nurse took me down a couple of floors to a nurses’ shower room and I got a shower – I felt so grubby. I washed myself, and washed my hair with lather from hand soap. My hair felt like straw afterward. When I was dry and dressed I went down to my car in the garage and got my Book of Common Prayer, and some bottles of water, then went to the hospital cafeteria and got some cereal and yogurt and a cup of coffee of which I could not drink much, then went back to Rick’s room, where he was much the same. In fact, he was a little more stable than he’d been the night before. I hoped he might wake up, but he never did, though his eyes opened a couple of times and stared, unseeing, before closing again. I read to him from the Book of Common Prayer, and held his hands, and talked to him, and sang some more. The singing seemed to calm him a little. Around one the first thoracic surgeon came back. He provided me a little dark amusement by telling me that the fact he was there was proof that Rick was getting the best possible care the hospital had to offer. I didn’t laugh at him. That would have been rude, and of course I was still hoping he might save Rick’s life, but I did think that, wow, everything I’ve heard about surgeons is true. Surgeons and pilots. Well, because Rick was confounding them by doing so well this surgeon thought that he’d try to finish the shunt procedure. Perhaps getting that drain into Rick’s lung could make the difference and he’d turn the corner. I had to sign a permission form which acknowledged that the procedure could result in cardiac arrest and death. I was sent back to the waiting room. It was not long before Dr. I’m-the-Best came in and said, “It’s time to make your good-byes.” So I went in to Rick’s room, stood next to his bed, held his hand, touched his stubbly cheeks, thanked him again for loving me and giving me the life I wanted, sang a little more, watched the numbers drop on the monitor. The ventilator was turned off. His breath came sporadically, and was very shallow. His pulse was slow and reedy. “Can we turn off all the alarms?” the respiratory nurse asked. I guess they did, for it was silent then, and the monitor was no longer on, and there were no more heartbeats, and no more breaths. He was silent, and still, and peaceful. After a minute or two, I said, “I think he’s gone.” “Yes, he is,” said Lesley, the nurse who was standing at my side as I sat with him. I said, “He struggled so long, and at the end his spirit lifted like a butterfly that was blown away on a gust of wind.” “Yes,” Lesley said. At that moment everything fell away except the love. There was nothing but love, all the good stuff. Our son Drew arrived soon, and he and I cried together, and we sat with Rick for a while. When Drew said he was going to go play music, which sounded like the best possible thing to do, I decided I would not stay on alone with Rick, so, a little over two hours after he died, I said good-bye for the last time, and left. As I drove by the steel foundry at the bottom of the hill going up to West Seattle, a stack blew a smoke ring and I laughed. Rick used to watch that stack like a hawk, waiting for it to blow a smoke ring, and there it was. He would have loved that. That was a week ago Sunday. The first few days I was simply stunned. I didn’t know what day it was until Thursday. I’ve been signing papers and making decisions and helping to plan a church service and picking a spot to bury the urn of ashes. I’ve had dozens of phone calls and have received dozens of sympathy cards (and I love those cards – they mean the world, they truly do), and I have discovered the very best part of Facebook, where people have been infinitely loving and supportive. So many people weep at Rick’s passing. I cried the first days, but have been dry-eyed since. I know a time will come when I’ll crack like an egg and sob from the bottom of my being until my ribs hurt and I gasp for breath. It won’t be pretty so I want to do it alone, but it will be a great cleansing milestone and I’m looking forward to it. I’ll never get over Rick’s death, never. It is amazing to me that the forty-one years I knew him seem like the blink of an eye – all the music, the marriage, the sex, the laughs, the hard times, raising the kids, the years of illness at the end – a blink, but it feels like forever since he died ten days ago. I will be all right. I know that. In time. Maybe my brain will begin to function again. I was ever absent-minded, but now I can’t remember from the beginning of the sentence what I meant to say at the end. I drift. I forget everything. A friend advised me today that when I set something down and want to remember where it is, I should take a picture with my cellphone. This sounds like a great idea, but I don’t know where my cellphone is. I’ve called it twice today to find it. People are being great, really wonderful. They are giving so much. And I bumble along, accepting it all with a gratitude I hardly feel capable of showing. I will be glad when the service is over. I don’t know if I can face all those people, but I will. I don’t feel lonely, except for sometimes. I lie in bed and look over and say, “Where are you?” I bury my face in the sheets and inhale. I get shaky sometimes. I feel like I might throw up a lot of the time. I read lightweight novels. I play scrabble on the Kindle as an almost magical activity: he was still alive that day when I was playing, he was still alive at first. I sleep for an hour and wake up, and go back to sleep, and wake up again, all night long. I feel exhausted all day. It’s not as bad as it might sound. Like I said, I don’t remember one minute to the next. I guess that’s a natural self-protection. Over and over I think of a catch phrase Rick hated for its meaninglessness: “It is what it is.” Yeah. It is.

Chris Howie, left, and Rick Tuel, right, December 19, 2013