Things are settling in nicely. Now physically at the hospice, they’ve situated me in an amazing one bedroom cottage. It sits cliff side on the far western part of the property. The repetitious yet constant sound of the breaking waves flows through the windows and renders me entranced. So far, the people here are downright kind, and I am already encouraged. If last night is any measure of what I am to experience, then I am right where I need to be…

 

A familiar, though indescribable, feeling has started to grab hold of my senses this morning. My father’s memory has been drifting into my consciousness with increasing frequency the past few days. Today I feel closer to him than I have since far before he died; maybe the closest ever. I am beginning to trust the idea that I am being guided by his grace. With this notion, new warmth rolls in my chest, tumbles up my neck, and into my head. Skin and hair both rise to capture the heat, making myself seem larger than I am. It could just be last night’s rum talking, but my head definitely feels a bit larger than it should be today. When my head gets too big, the only thing I can do to decompress it is write – sometimes it takes the form of a poem.

 

 

***********************************************************************

 

 

Learned and Wise

 

An event takes place that changes minds;
Some call it fate, showing its sign.

 

Others see it too, with eyes opened wide;
And claimed that it grew from relative time.

 

Some say it is God, dealing His hand,
Giving beauty to reason over His lovely land.

 

Many call it logic, programmed and planned;
Expecting an outcome, a winner of chance.

 

Greatness is seen
By those who can see
The beauty in Nature
That shows constantly.

 

Observing is capable
By people who need;
A sight to behold,
An idea that could seed.

 

Unfolding life
Is beauty through eyes
That comes from a soul
Learned and wise.

 

 

***********************************************************************

 

 

After joining up with an impromptu bar crawl through downtown on Friday night, I awoke to the relentless clanging of steel drums. Apparently the God-damned resort has a live calypso brunch every Saturday morning. I appreciate the festivities, but there was no mention of this when I checked in. I remain indebted to the makers of generic ibuprofen, and grateful for my complimentary bedside spring water.

 

There is nothing quite as unnerving as the combination of the smell of burning spinach and onion quiche, the fuzzy taste of a rum hangover, and the sounds of a local steel drum band covering Legalize It. I can’t even begin to describe the wrathful punishment that I was ready to inflict this AM when my senses exploded and woke me from a deep slumber.  My initial rage slowly dissolved as I realized it was 10am already, and it WAS Peter Tosh they were playing.

 

Once I stumbled out of bed, I soon realized that I didn’t have to be at Altamount for several hours. I had to fill the time gap, and I needed to get myself sorted out beforehand. I certainly wanted to make a good impression.  I am aware of no remedy equal in efficacy to that afforded by a morning swim in the universal solution (the salt water). In my book, it is the one true medical panacea.   When my room eventually stopped spinning, I jumped in a taxi that brought me over to Cinnamon Bay. A walk down the beach, and a long floating session in the 80 degree water turned out to be just what the doctor ordered.

 

After lunch I became rather anxious anticipating my first meeting with the hospice team. Evening slowly crept in like a nervous cat after shaking the tin containing her favorite treats. You can hear her coming, but you’re left to wait for things to get cool before she moves closer.

 

Check-out time had come and gone already, but my anxiety was still surging. I still needed to get right and even before dinner. I required two hundred sit-ups, one hundred push-ups, and a cold shower. This was my  go-to self prescribed measure to mitigate most panic attacks from developing.  Sometimes it works. Sometimes I need to add a shot of tequila to the mix.  I slid on my backpack, reached for my suitcase, and trusted the faith that I had on hand. I decided to take the mile walk up to the property. Cautiously I took to the road slowly hiking its oscillating grade.

 

 

 

 

As I approached the driveway to Altamount, I was at first taken by the amazing flowers and the thoughtful landscape design. Hibiscus and oleander flowers made for stark contrast to the yellow cedar and cactus that are exploding through the gardens everywhere. There was a cock-eyed iguana that appeared to be the security guard on duty. He sat contently under the entrance sign – seemingly with at least one eye on everything. The driveway wound slowly upward around the perimeter of the property, giving me a chance to look around.

 

Just as the silhouette of the main house came into sight, I walked upon an older woman in a straw hat. She was gently picking flowers out of a raised garden bed on the side of the driveway. With a bright smile and a wooden basket full of lush reds and purples, she sang.

 

“Welcome to heaven, beautiful.”

 

I’ll admit, not the welcome I was expecting, but she obviously meant it. My teeth came out ear to ear. She welcomed me,“My name is Phyllis, and you must be Mark…”.

 

Immediately I wondered how she knew my name, and who she was. But before I could entertain any of my fantasies, she yell-giggled, “I’m so glad you’re with us!”

 

I have to admit, the voice that I heard coming from Phyllis was not the one I was expecting to hear. Being in the islands, my mind is prejudiced to think that every black person I come across will have a distinct Caribbean accent. Not Phyllis though, her voice resonates with a slow southern drawl.

 

As it turns out, Phyllis Jackson is actually a client at the hospice. She happened to be out picking some flowers to place as the table centerpiece of tonight’s weekly group dinner. Sensing my nerves, she took me by the hand and led me up the main house.

 

On our way up, I took the chance to relate to her slow, loving, southern charm, with my quick, cunning, northern wit. Immediately, I could tell we had a connection.

 

As we walked slowly, Phyllis disclosed that she was a retired waitress from Newport News, Virginia. She had been diagnosed with a localized pancreatic cancer four months ago. She mentioned that she had now been here for three “glorious weeks.” She also let me know very early in the conversation that her son was none other than Theodore Jackson, a rookie running back sensation for the Buffalo Bills.

 

By getting her here, Theo was “taking care of his mama”. After all, this place seemed the best at what it was; and so had she been to him… No expense would be too much for the good karma this woman had coming her way.

 

Come to think of it, I remember a Monday Night Football story on Theodore “Action” Jackson, in which the color commentator had actually referred to Phyllis’s situation indirectly. Holy shit, here she was, guiding me on my way ahead.

 

I asked her directly, “Phyllis, how do you make sense of this place?” I think maybe she assumed I was inquiring about her understanding of her illness.

 

She replied, “Honey, this place ain’t about me understanding it…It’s about it understanding me… I have spent my life loving all that was right; singing praise to my personal savior Lord Jesus Christ every morning since I was a girl… My life, as hard as it ever got, was never more than providing for my family… And honey, as what goes around comes around, my boy’s taking care of me…”

 

Her reply really didn’t get to answer my question, but certainly I couldn’t argue with her fatalistic logic. After all, it is part of what’s helping to keep her sane in this presumably insane time in her life. I thanked her, and gave her probably the first hug I had really given to anyone in a year. It felt right.

 

After initial greetings with the Simon brothers, I was escorted over to the biweekly family style dinner they had for the clients, staff, and their families. Phyllis kindly went out of her way to introduce me to everyone. There are many names to remember. 5 clients (3 of them with families present), and 7 staff members participated in the meal.

 

I sat next to Andrew, one of the doctors, and co-director of the hospice. He seems to be a charming and rather boisterous spirit. He also seems to enjoy the wine. It was no long into our first conversation that I was sure that he knows his stuff.  I think I learned more in 30 minutes of talking to him about cancer than I did in my entire hematology/oncology curriculum in my first year of med school. I know I will learn a lot from him.

 

On the other side of the table sat Sarah James; another of Altamount’s clients. She is a sixteen year old girl from northern California. She has been living with an inoperable brain tumor. You might never know by just looking at her.

 

Everyone was welcoming. Everyone talked to me. I was encouraged and all of my previous anxiety was totally replaced with hope. With the genuine smiles that I could see around the table, I could hardly tell there was sadness in this place. I don’t quite understand it from the outside looking in.

 

The patio where we sat faced the setting Sun. The massive dark orange orb fell quickly over St. Thomas, leaving only opalescent clouds and the faint early evening stars to watch over us. When the distant lights of the neighboring island came on across the water, house by house, we all shared our stories.

 

I listened intently to theirs, and then disclosed my own. I tried my best to describe who I thought I might be and why I had come. For some reason, I think they already knew.

 

 

 

Entered weeks later (June 7, 2008)

When I had first encountered Phyllis in Altamont’s driveway, her social graces totally distracted me from the evidence of her pathology. It wasn’t until we had several other encounters in the days that followed that I began to really notice the effects of her progressive malignancy.

 

In the setting of her metastatic pancreatic cancer, her liver was being affected. With dark skin, it was hard for me to appreciate her elevated bilirubin, until I looked into her eyes. It was clear that the usual white sclerae, were actually getting more yellow. Her belly was distending, and she required repeat paracenteses (drawing fluid out of the abdominal cavity with a needle) with increasing frequency. These changes didn’t stop her from going out and gardening. It was her eventual change in cognition that did.

 

In her final days, Phyllis experienced significant mental status changes which required several medications in order to keep her calm and comfortable. She began to demonstrate disorganized thinking, disorientation, hallucinations, and increasing periods of somnolence. The Simon brothers thought it was most likely due to an encephalopathy related to her liver dysfunction. They also relayed to her family that there were other factors influencing her ability to think clearly including the medications they were using to keep her pain free.

 

Detailing Rita’s condition, the doctors introduced a new term to me.  It was something called “terminal delirium.” They noted that most patients experience some degree of cognitive function loss in the week or two before death. Terminal delirium is a sort of  blanket term used to describe a constellation of symptoms. It encompasses the most common causes of delirium including (but not limited to) medications, metabolic derangement, infection, and/or CNS pathology. This description was helpful for the family especially to normalize her experience. Appreciating how sharp and socially engaged Phyllis was, it was so hard for them to see her in this way. What she became was not her. In a humorous interpretation of the concept, Phyllis’s daughter commented that “Terminal Delirium” would make a great title for Tyler Perry’s next airport comedy. S

 

It was a blessing that with medication support (haldol/thorazine), and non pharmacologic treatments mobilized ( reducing environmental sensory stimulation , frequent reorientation, and having familiar faces and items present), Phyllis did not suffer. Her family surrounded her in love and prayer in those final moments – and perhaps that was the most potent treatment to keep her present and calm.