Some emails from the the last days of Mary's life are shown below, in reverse chronological order. Added notes are italicized and red in brackets.

Jan 31 (Cathy to family members)

Mom threw up everything she ate for dinner tonight, which was not much. She is down quite a bit in weight, although I suspect that you could subtract 20 lbs from her already low weight and attribute it to tumors in her abdominal cavity. She has deteriorated very quickly over the past few days, and due to the pain meds is slow and sleepy much of the time. When awake she is mentally sharp. She knows what is happening to her, and is aware that she doesn't have much time left.

I plan on staying home from work this week. I have lots of sick time available and my guys are competent and able to run the office in my absence. I feel I'm needed here more than at work. [Cathy had not been at work since Jan 21—he sensed more than anyone how dire her mom's condition was.]



Jan 30 (Me to family members, two days before she died)

This is to update you on Mary’s status.

Justin, a Kaiser Hospice nurse, spent almost 3 hours with us today. Mary is now under Hospice care. It would have started next week, but due to the pain she is experiencing she jumped the queue. To alleviate the pain (12 on a 10-point scale, she told Justin), she is now on Percocet (I think it’s just below morphine, as a pain combatant). Percocet knocks her on her butt. We are likely tomorrow to order a hospital bed—one that goes up and down at the push of a button—and put it in the living room. We would move her meds and stuff for personal hygiene downstairs and she could take a shower downstairs. How much time she would spend in the bed as opposed to in front of her PC we won’t know for a few days. The bed may be ordered tomorrow and also delivered and set up tomorrow—that’s the way hospice works. [It was ordered and delivered on the 31st, and set up downstairs. Then David and Brian, who had just arrived from Berkeley on the 31st, moved it upstairs into our bedroom, at Mary's request. She wanted to stay upstairs. However, she was not moved into the bed until the 1st, around noon, by Paul, a Hospice nurse. At that point, she could not walk at all or even move much—he and I moved Mary from our bed to the hospital bed by manually sitting her up, sliding her into a wheelchair, rolling it to the other side of the room, lifting her from the wheelchair, and positioning her into the hospital bed. She died less than eight hours later.]

This is all a huge change. I had suggested earlier to our kids that Cathy would be in touch later this evening. I just spoke to her and she said that this email will do instead.

She will make no more visits to the Kaiser hospital. All doctor visits have been canceled and she is now under the care of Dr. Russak, who I suspect will not visit her, but all Mary’s nurses report to him when they need a doctor’s decision. [Dr. Russak did come by, on Jan 31, and signed the POLST—see below.] Of course, everything is on Kaiser’s computers, so can be reviewed from anywhere. We now keep a HOSPICE binder on prominent display. Inside are agreements we’ve signed which contain details I’ll read tomorrow. On the cover are names and key phone numbers. If Mary needs urgent medical care, we call one of the numbers on the cover. Tonight a package will be delivered that we are not to open; it contains some medical supplies including morphine, that can be used if needed by a nurse who can arrive soon after we declare a medical emergency.

We have completed a POLST (see, which everyone over 65 should have on prominent display in a house. An Advance Care Directive has no standard structure, and the checkboxes in it may be hard to find, and it is likely not easily located in a medical emergency. The POLST is pink (visible, easy to see), in a standard format, covers some key issues that an Advance Directive does not, and the POLST must be signed by a medical person.

Mary has stopped six of her meds, including three used to treat cancer. The idea is that she is to be made comfortable. She is eating virtually nothing: today a bite from a muffin in the morning, a drink of lemonade for lunch, and virtually nothing for dinner. [In the morning, when the biweekly house cleaners were here, we went out for a couple hours, stopping at New York Deli to kill time. Mary ordered a muffin and took one bite. That was the last food she ate. Claudia and Loren Grossi, old friends and teachers, happened to drop in while we were there. We had a pleasant conversation with them, one I dominated—Mary said little, as seemed to have lost much of her sharpness. We went home and she got in bed. She never left it after that except to go to the bathroom.]

Her stomach is riddled with cancer; organs including her kidneys and liver are impacted. She went to the ER Sunday night due to excruciating pain; ultrasounds and a CT scan revealed it was a tumor on her liver.

I’ve never been through this before, so I do not know how long she will be with us. Cathy and I are doing everything we can to make her last days pleasant ones. I had thought she was depressed, but she told me today she wasn’t—I had interpreted her head on her chest as a sign of depression. She said that the meds make her tired. She’ll read on her Kindle and then doze off. I’m starting to choke up, so I’ll sign off for now.



Thu Jan 25 (Mary to family members, after visit to Dr. Wilkinson, the pulmonologist, who gave Mary a very bleak prognosis)

So, the x-rays today didn’t indicate much fluid to be drained, and the thoracentesis [draining fluid from the cavity around her lungs] Next step will be hospice care, which happens when the doctors say you have six months or less on your timeline. We’ll probably get that started next week. [She was put into Hospice care by the cardiogist on Monday, Jan 29.] Tough call; I didn’t envy the pulmonologist having to tell us. We knew this would come, just not when. Time to circle the wagons, finish my various lists of things to be done and prepare for how things will be. On the positive side, this may mean I won’t have to take the sick-making pills and will have some weeks of peace and normalcy. Not the outcome we’d hoped for today, but there it is. Hospice and palliative care bring with them additional support (pain-management drugs, R.N. coming to the house, etc.) and it will be welcomed.

Hang in there with me!



Tue Jan 23 (Mary to kids and spouses)

On Thursday I will have a thoracentesis done in Woodland Hills, to remove fluid from the pleural cavity around the lungs. I’m hoping to feel lots better afterwards, based on what I remember from last fall when they did this before. Fingers crossed that this will help! I expect to come home afterwards, as hospital overnights are not a favorite in my life.