Telling Mildred: Reminiscence of an Untimely Death, Part I

September 21, 2001
[Cleveland Heights OH]

Dear Aunt Mildred,
[Anoka MN]

I have been having a hellish week as a substitute teacher at one of Cleveland's roughest schools, Margaret Spellacy Middle School in south Collinwood. Jean was indeed very special and we all miss her greatly even though her sudden death is now overwhelmed by our national tragedy.

Emily is fine to my knowledge. She called me personally on Tuesday September 11 at 4:26 PM to say she was safe. Her offices were not in the World Trade Center but were very close. Ordinarily she walks through the WTC area every morning at 8:45 AM on her way to her building. That day she had missed her train, and if I recall properly, she stated that when she emerged from the subway on Fulton Street she saw people already evacuating the tower that was first hit, that building parts and body parts were still raining down on the crowd below. The subway going back to Grand Central was either unavailable because of overcrowding or not running, so she joined the people in the street and ran the fifty blocks back to Midtown. I cannot tell from her e-mails whether she can speak of the event easily; I have asked her to provide more details. When I hear I'll let you know.

Jean knew she was dying. Jean was an intelligent, well-educated medical professional, from whom no one could, or would want, to hide the truth. Of all her various ailments she had no idea that she would be in such serious danger so fast. Toward the end of July she was complaining that her back hurt and she could no longer work. She asked for a leave of absence for medical care. Doctors confirmed her spine suffered a "compressive fracture" in the mid-thoracic vertebrae (right about where a bra connects in back).

She had also changed her eating habits in that last free week to where she would prepare a meal but eat very little or none, and would pass the food to me, "Hey, I can't finish this. You want it?" or "I thought I was hungry, but now I just don't feel like eating." She could not sleep because she could not find a comfortable position due to her back pain. She would toss in bed or cry out in pain, then rise and go to the lounge chair in our TV room. Then, just as shortly she would try the bed again. By July 31st she had not slept for several days. On August 2nd she was scheduled to see her diabetic consultant to discuss her performance on a new insulin that appeared very promising for her.

The consultant, Ann Williams, who is also a friend of ours from church, instead recommended she see her doctor. As Jean's was away with family in Israel for another few days, Jean saw her colleague Kara Browning, MD. Dr. Browning recommended Jean be taken to the ER at University Hospitals instead of going home. Jean was found to have blood anomalies, a fever, and her pain was worsening. The ER took twelve hours to admit her (5PM to 5AM). Jean was now found to be suffering from ascites, a fluid inflammation of the peritoneum. Plainly her abdomen was swelling with fluid gathering in pockets throughout her belly.

That Thursday you could almost watch her grow as you sat bedside. They tried a procedure called parascentesis, in which a needle was driven into her belly to draw off the fluid collecting there. On Friday they attempted to take out three liters but removed only 100 ccs (about a thirtieth of what they expected). Jean had been promised wonderful relief, which did not occur, and her pain was worsening, more severe and more frequent. She did not resume eating as whatever she tried she shortly threw up. I slept in the room in another bed from Friday night, waking to all her pain meds and other tests, blood samples, oxygen readings. Still she hardly slept and then only with great difficulty. She looked as if she were pregnant with triplets at nine months and could find no comfort in any position for long.

On Saturday they tried the parascentesis again this time guided by ultrasound imaging. Pretend you are trying to puncture water balloons in a sealed box mixed randomly with air balloons. Drain a water balloon and you've alleviated the swelling; puncture an air balloon and you've perforated internal organs causing massive bleeding. On Saturday they did manage to drain about 1300 ccs. There was no anticipated relief as anything Jean drank caused the pockets to refill. She was in as much trouble a mere six hours later. By now she was receiving morphine heavily and regularly. That afternoon after they had drained her she was able to see family and tried playing Trivial Pursuit, but by 6 PM she was exhausted and again in great pain. 

Later that night a visiting doctor asked her whether she had made a Living Will, a document that specifies the conditions under which life support may be terminated. The doctor said if we had made such a will, the hospital would need a copy. This was very upsetting to Jean as she knew what it meant: that the hospital realistically had to consider that she might die and soon. I tried to assure her that it was only one option they needed to cover. To no avail as she was seriously frightened that her death was  now certain. 

At church that Sunday the mode was very informal since the pastor was away on vacation and substitute preachers were engaged for those Sundays.  The woman preacher asked if anyone had anything special to pray about and Peter rose in the balcony to state his mom was in the hospital, seriously ill. Few looked back to recognize the voice. There was no bulletin announcement because Jean went in on Thursday, a day after their printing deadline. 

In the hospital that morning the resident announced that it would be all right to administer Jean 24-hour morphine, as much as she wants, whenever she wants. Also she was rigged with a nasal oxygen supply to help her breathe. She continued to refuse all food. She accepted a couple spoonfuls of lime sherbet and ice chips. Even then she threw it up only a few minutes later. Staff brought us news that the first fluid sample contained two anomalous cells. The report from the larger sample taken Saturday would not be available until late Monday or early Tuesday.

Also on Sunday Dr. Abby Abelson, Jean's pain doctor, who had returned from Israel the day previous, spent about an hour with Jean in the afternoon. Somehow they had struck up this incredibly deep friendship over the years and Abby had come this time to see Jean more as a close friend than a patient.

I'm sorry I can't tell you more in this letter. I have some errands to run and some deadlines to meet with other writing. 

Peter is with me now but he sometimes stays at school or his girlfriend's. Andy is in Florida on an acting internship in orthopedics. Nat's at Carnegie Mellon in his last year. 

Sincerely,

Jim