Occam's Razor

For every Walter Cronkite who passes on, there are thousands of prominent people who warrant obituaries but rarely make the national news. Two notables in the Washington region passed recently, both of them developers. Abe Pollin was perhaps best known as the longtime owner of The Washington Wizards, but he made his fortune in the construction business. Pollin’s most notable achievement was probably building The Verizon Center in downtown Washington where his beloved Wizards played. Robert H. Smith though probably made a larger architectural impact. His buildings were rarely noteworthy, but he built so many of them (mostly look-alike upper end office buildings with marble faces, large windows and with adjacent multilevel parking garages) that they became ubiquitous. They house lobbyists along K Street and beltway bandits out in McLean, Virginia and Bethesda, Maryland. Crystal City (which is not an incorporated city) is perhaps his best-known creation. The huge complex of office and residential high rises goes on for more than a mile. It frames the west side of the Potomac River and offers prime view of our federal city.

Of course, for every prominent obituary, there are many other thousands whose lives do not seem to merit an obituary. Sometimes the family will not even bother to pay for a death notice. Dying is rarely a tidy business. Fortunately, there is usually someone around responsible enough to do the hard work of caring for someone nearing the end of life. They are usually family. This is true in the case of my friend Lynn (not her real name).

More than eight years ago, she noticed that her sister was becoming difficult to reason with. Her sister has always been somewhat difficult and irascible. She did not take care of herself and smoked like a chimney, which unsurprisingly caused her to also develop emphysema. Still, giving up her cigarettes was unthinkable. Lynn has one brother who has family problems of his own. Since Lynn is sixty something, her parents have long passed on. As her sister’s faculties declined, she started to become a danger to herself. For example, she would forget that she was leaving lit cigarettes lying around.

Her sister also inconveniently lived fifteen hundred miles away in Colorado. Lynn had two choices: to let her sister to fend for herself or to rescue her. Her sister smoked constantly and everything she owned reeked of tobacco. To say the least, taking on the chore of acting as her sister’s guardian was not appealing, but love won out. Largely by herself, she relocated her sister to Northern Virginia, amongst much crying and cursing by her sister.

Her confused sister felt upset and betrayed. She did not want to come to the east coast; the Rocky Mountains were her home. For a while, they were uncomfortable roommates in her modest house. Finally, she found her an apartment in an assisted living facility a few miles from her house. Meanwhile, Lynn grappled to find her sister the medical and psychiatric care that she needed, with few ideas on how to do so other than to call the county’s office on aging. It took months to find her the right social workers and specialists so that her care was adequate and she was safe. For a few months, she visited her sister weekly and relaxed. However, with each visit her sister was more confused.

Recognizing that she could not depend on assisted living much longer, Lynn began searching for a nursing home for her sister. She discovered that most of the nursing homes were not suitable for her sister, or even most of the patients that lived there. Staffing was short. The staff looked hassled, overworked and underpaid. Care was substandard. She finally found one that she thought would work for her sister, but her sister refused to go. So they paid periodic visits until she began to feel more comfortable with the place. The nursing home felt more like home in part because she had trouble retaining long-term memories. Her mind was going. She recognized her sister less and less.

Eventually she settled into the nursing home. For a while, it was like scenes out of the movie Away From Her. She seemed quite happy and for a few more months, Lynn could relax and visit weekly. Yet, with each visit her sister seemed a little more distant. After a while, she forgot her name entirely. Surprisingly, she stopped smoking, in part because she forgot it was something she wanted to do.

She began drawing on the walls and sleeping in until noon. Then one day she fell out of bed. For hours, no one noticed until someone found her on the floor. She was in great pain. Lynn was summoned. Her sister’s hip was broken. She was quickly taken into surgery. The hip was replaced but she immediately made a turn for the worse. Her surgical pain was horrendous. She screamed for hours and no one in the hospital cared. Lynn spent hours trying to get the attention of doctors and nurses and was largely ignored. She stopped eating and drinking. They tried to force feed her but it all came out through her nose and mouth. There was also blood in her urine. By this time, she weighed less than ninety pounds.

Lynn eventually got her sister some excellent narcotics, but the doctors kept wanting to do more invasive tests and force feed her. Lynn retrieved copies of her sister’s living will, but it took over a week before she could convince her doctors that she would not sue them for negligence and that her sister did not want her life artificially prolonged. Tonight, her sister is in the final stages of dying. She hasn’t eaten in more than a week. Her body is rapidly failing.

Lynn chose to speak for her sister. At great personal pain, she made the awful decision to not artificially prolong her life. At great expense to herself, she stood by her sister, the same sister who so often treated her shabbily. There was no one else to do the dirty work. She did it both out of a sense of compassion and duty.

She cried last night in my covenant group while relaying her story. We held her hands, gave her hugs, and made sure she had all the time she needed to share her feelings and her story. It is ironic that at this very time a new man has entered her life, someone she met at the hospice whose wife died some months back. Sometimes moral support comes from the oddest directions.

As drawn out as her sister’s dying has been, her sister is blessed. Despite the odds, she has a compassionate and loving sister who cares for her for years while knowing that her end was destined to be bleak. Some of us die on street corners, others of hypothermia, and some alone in our apartments, unable to dial 911 and with no one to notice until the rent is past due and the landlord busts down the door. Some like my wife’s wayward father end up as an indigent in a hospital room with no one to notice their passing. Lynn’s sister at least had her.

Lynn’s hard work these last years is as notable as Robert H. Smith and Abe Pollin’s building and stadiums, if not more so. If no one else will do it when it’s Lynn’s turn go, I will do my best to be there for her, for she is childless and will likely be the last of her generation. Compassion should always be given out indiscriminately, but even with family, it is hard to summon the courage and make the commitment. Lynn has earned the compassion she too will need some day. I and the other members of her covenant group will make sure she receives it.