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Meri Lobel lost her brother to cancer. Being a friend, she volunteered to come to the Death Education class and express her thoughts and feelings about her brother. The following is a transcript of that class.
Q. Would you please give us an account of what happened?
Meri: My 37 year-old brother, David, lived in California. He contracted lung cancer about two years ago. He went through a fairly long process of chemotherapy, and was somewhat healthy with those treatments. In fact, he would often say, "Thank God for these drugs, I feel wonderful!" Last December his body started to break down from all the treatments. The red and white blood cell count started to deteriorate after a long period of time on chemotherapy. He entered the hospital in January. Although it is still a question, a secondary cancer invaded the stomach and he was not able to eat solid food for the last month of his life, and he really could not drink anything for the last two weeks. He went into a semi-coma about a month before he died and the doctors thought he had only 24 hours to live. Living in New York I had to fly out to him before he died. My parents flew out there from Georgia where they live. He seemed to recover, knew everything that was going on, and could talk the entire time. He did not want to die in a hospital. He wanted to die at home. He improved enough to be transported by air-ambulance to my parents home in Georgia. He was my only sibling, and now I am an only child. Now I have to deal with 2 parents alone, and it is a lot easier to deal with 2 parents and their craziness when you have someone to help.
Q. In your opinion, what was the cause of your brother's lung cancer?
Meri: Although I am not sure, my father was a 3-pack-a-day smoker, so we grew up with a lot of smoke in the house. My mother's father died of lung cancer when he was in his forties and was a 3-pack-a-day smoker also. But we, and the doctors, do not know how he got the lung cancer.
Q. What was the hardest thing for you throughout the entire ordeal?
Meri: There were two aspects to it. The first, when he was sick he would have a lot of highs and lows. He would have a low day and I would think of flying out there. The next day he would seem to bounce back, as did the family. He had a great sense of humor and would joke about it alot. We knew he was going to die eventually, but were always hoping for a cure that might change things. The second thing was now that the whole process of him dying is over, I now have a new process concerning being an only child beginning.
Q. How did your brother treat his impending death.
Meri: Basically he denied the fact he was going to die until the very end. One time he went into crisis and the family flew to California expecting him to die, his reaction was to question what all the fuss was about. Although he knew the doctors were predicting his death he said he was not ready yet. He would say things like, "My bags aren't packed." and "The ship has not come in." He was joking about the whole thing and was not ready to go. He really seemed not to be ready. I tried to get a will written to take care of his property and insurance. I had health proxies to be signed to avoid resusitative efforts. We wanted him to decide who was to get his car and his ring. He refused to deal with them. We had a difficult time in getting him to focus on his death being eminent. He didn't want to deal with that. However, when he arrived in Georgia he stated that he did not think he was going to make it there. Within a week of being there he still could not eat or get out of bed. My mother would ask him what he wanted to eat and he would say, "Lamb chops!" She would make his favorite meal, and he would eat one piece of the different foods and that was it. So, those things he was blaming on the hospital now he had to blame on his condition. It was at this time he knew he was not going to get any better so he started to talk about it a little bit more. About one week before his death he did say he wanted to be buried in Georgia. And everything about his death that he finally came to grips with was done in the final week of his life.
Q. Was he older or younger than you?
Meri: He was three years younger.
Q. Where did his will direct everything to go?
Meri: My parents basically got everything. The feeling was, since I would inherit everything from them eventually. I did get his CD player and CD collection. The car, a black TransAm, went to one of his friends in California. He had a lot of friends including two girl friends. He had one in New York, who came to the funeral, and one in California. The one in California met my parents when they flew to L.A. His friends all knew each other. They all seemed to get along. For example, a past girlfriend from high school and one from college knew each other from meeting on a trip. They all tried to make it the best for my parents and for me.
Q. Are you aware of the famous, "Five stages of death?"
(The stages of death were briefly explained at this point.)
Meri: I think denial kept him going for a long time. He skipped the middle three. [Anger, bargaining, and depression.] He was never angry. He accepted what he had but was fighting dying over it. That is what kept him going for almost two years. I talked to him almost every day for the last year and did not see the anger. I didn't see much depression except when he expressed displeasure over being in the hospital. He wanted to die with his family around and definitely did not want to die in the hospital. This made it very difficult on my parents. He wanted to be resusitated unless he was brain-dead. When he was in the house he had round-the-clock nursing all the time, but still wanted my mother to be there all the time. So she would sit in his room all day long. The only time she would leave was to get the mail or when she went to sleep. So, over three to four weeks she saw his condition deterorate every day. When he was healthy he was 5'10" tall and weighed 140 pounds. When he died he weighed less than 85 pounds. He could not eat for the last two and a half to three weeks. He had a morphine drip and could press a button to get any amount of morphine he wanted. He started with the smallest amount possible because he wanted to be totally aware of his surroundings. The last week he was pressing it so much they upped the concentration to three or four times the dosage.
Q. Was he drugged out at the end?
Meri: No, I talked to him the day before he died. He said his body felt very funny. Because he had been in denial for so long, this statement led me to believe his denial was breaking down. He was now fighting to stay alive rather than fighting to get better. He got past the milestone of his birthday on April 27th. The morning he died I talked to him at 8 A.M. and he was still quite aware but knew his body didn't "feel right." He wanted to live through Mother's Day. He made my father go out and buy my mother flowers. He wanted me to go down there for Mother's Day, but ended up dying at 5 o'clock Saturday afternoon, the day before Mother's Day. He had been sleeping most of the afternoon because they had increased the concentration of the morphine drip. He woke up about 3 minutes before he died and asked for my mother. She had stepped out for a brief moment to get a cup of coffee. He called out, "Mom! Mom!" and then he died. Interestingly, I talked to him in the morning and then went out for the rest of the day. I decided to call him in the afternoon and called him the minute he died. My father answered the phone and said to get down there right away. It had taken 6 or 7 rings for him to answer the phone and that was unusual. He died as my father was talking.
Q. Is it harder to watch someone die over a long period of time, such as your brother, or to have someone die fast.
Meri: I've lost a grandfather quickly because of a massive heart attack. That might have been easier because the memory is a good memory. When I went to California and my brother was nothing but a skeleton at 100 pounds, I find it is hard to get the memory out of my mind. My mother says she has dreams every night of my brother lying in the bed at 85 pounds. He was very thin. You could see his bones and everything.
Q. Describe the funeral.
Meri: The way they did it in Georgia was to have the funeral at the burial site. First the body was taken to the funeral home. I flew down there the next day and helped select the casket. He was transported to the cemetery. The casket was closed and in the setting of the Magnolia trees it was very pretty. I read the eulogy that I wrote. The first and last paragraphs were very hard to read because of the emotional level. Following that we each took a rose from the spray that was on the coffin and left. Therefore we did not see him after he died. That was my choice anyway. It's easier for me to look at a photograph from 3 years ago than to look at the body in the casket.
Q. It is thought to be therapeutic to see the body in the casket. Wouldn't it have been better for you to have done so?
Meri: For me, I certainly knew he was gone and did not have any need to see the body in the casket.
Q. Did you talk about the death with your parents after the funeral?
Meri: Understand my parents are very unusual people and my father does want to deal with anything like this, and my mother tends to be over-emotional. I know she feels guilty about not being there at the moment of death. She told me that. She was disappointed that she had stayed with him for so many days and hours and at the moment of death she was not there. We are talking now because we have to go through all the legal things. We probably will not talk about the emotional things. We were never a family to do that anyway.
Q. Did any of the relatives go through the five stages?
Meri: We were experiencing some of them while he was still alive because we knew he was going to die. The anger came out as questions like, "Why did he have to get cancer at 37. That's not fair!". There was anger because I handled family problems with my brother. Now, being an only child I am angry because my parents had only two children, and when they get older there will be no one of direct blood to help me with their problems. Because we were facing an eventual death there was a certain amount of depression. In the hospital we were facing a death that was not 3 to 5 years away but only a month or two away. That was very depressing. My parents took it out on each other more than they took it out on me. But, that's because that is the way they have always done everything and because I was not there. They would rather yell at each other, and I am away on the phone. To do otherwise would mean I would not call them. My brother was always the good one. He would call them all the time and if my mother needed someone to talk to he would listen. I was not very good at any of that and now I have to be. When they were going through all the things with the death, I had to call two or three times a day and listen to all the things I didn't want to listen to. However, I did not have anger toward my brother. He and I decided initially that we would not tell my parents it was lung cancer. Because my mother's father died of lung cancer we did not want her to get upset. She saw him go through this horrible death in 1947 when they didn't have all the treatments they have now. We didn't want her to think that was going to happen to my brother. They knew he had cancer and was undergoing chemo. We did not tell them it was in the lung until a month before when he was in the hospital. So, he and I shared that little secret. Prior to that my mother, who always asks four-hundred and forty questions, wanted to talk to the doctors in California and my brother would not give her the doctor's names or phone numbers. Finally, when she flew out there because he was expected to die within 24 hours she overheard a nurse talking about my brother's lung cancer.
Q. What was your mother's reaction when she did find out?
Meri: She wished she had been told sooner.
Q. Do you think it was fair to keep the truth from her?
Meri: I think it was fair because if she had known the extent of the cancer at the beginning she would have flown out there right away. That would have interrupted his lifestyle. Keeping the facts from her is what he wanted and I was going along with that. He did not want her flying out there, living with and taking care of him while he was healthy. He didn't want her to get crazy which she would do.
Q. Was there ever any bargaining?
Meri: Actually, we were hoping he would die earlier so he would not have to suffer.The bargaining was the other way. He wanted to live until after Mother's Day and my mother's wish was that he die before. He wasn't going to get better, was down to 85 pounds, and was in pain all the time. He was not going to get better at that point, so you are not bargaining to keep him alive. You are bargaining to save him from all that pain.
Q. I don't see you as being depressed. You seem to have an upbeat attitude. Is this a facade?
Meri: I've had my downs. The first week following his death there were a lot of people coming to the house and a lot of letters and phone calls. I was very busy with all that. That was terrific. Then it all stopped. I probably had the worst time two weeks after he died. I was extremely depressed. I did have people to help me through that time.
Q. Do you mind talking about the death now?
Meri: No. I have no problem talking about it. One problem is meeting someone that does not know my brother is dead and asks about him. That sets off a little reaction. It's usually shock. For example, I walked into the place where I work after returning from Georgia, and one person came up to me to say they were sorry about the death. There were three or four others in the vicinity that looked at me as you had one leg or arm. They did not know what to do or say. I've had two or three friends die of cancer in their forties, and I went through the end with them. I've learned you need to deal with it directly, and found they would like to talk to someone and do not want to be avoided. They want you to ask, "How are you doing?" and "What are your problems."
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