Tyrone Buchheim - My Father's Life and Death
My intention in writing this story is to provide me with catharsis and to better understand my relationship with my father, my family, myself, life and death.
My intention in sharing this story is to provide others with relatedness and comfort that they are not alone in their experiences and emotions…or with experiences and knowledge that they have never been exposed to (but might one day) that might help them and their loved one’s journey.
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Like many immigrants, Hyman and Helen Buchheim, both came to America, through New York City, at a young age. Although they were both born in Poland, it took thousands of miles and several years later for them to meet, fall in love, and eventually get married.
Hyman was a hardworking man, running several labor intensive businesses, such as installing and servicing building and auto glass, window blinds, and custodial services to commercial businesses. Helen was the homemaker and eventually mother to my father, Tyrone.
Tyrone’s Birth and Childhood
Tyrone Buchheim was born on March 12th, 1938 in Brooklyn, NY. It has been said that he was named after Tyrone Power, an actor who appeared in dozens of films from the 1930’s to the 1950’s, often as a swashbuckler or as the romantic lead. In addition to his given name, he was often called Teddy, Ted, or Ty; however, Teddy was the favorite. Unfortunately, Hyman and Helen experienced several failed pregnancies, which caused them great emotional and physical pain. As a result, Tyrone was raised as an only, but extremely well loved, child.
When my father was around seven years old, the Buchheim family rooted themselves in the predominantly Jewish Fairfax district in Los Angeles. Hyman relocated his business here and when he was old enough Tyrone assisted his father after school and on weekends. It was during this time that Tyrone became fascinated with magic. He enjoyed fascinating people with trickery, entertaining them in the process, and being the center of attention.
Tyrone’s Education and Career
Tyrone attended Alexander Hamilton High School in Los Angeles and graduated in 1957. He continued on to Santa Monica College, earning an Associate in Arts Degree, and then transferred to UCLA where he graduated in 1961 with a Business Administration Degree. In addition to his academics, Tyrone also served his country in the Army National Guard, earning the rank of Sargent.
Immediately following his honorable discharge from the military, Tyrone started his 22 year career with the California Department of Transportation, also known as Caltrans. As an Associate Right-of-Way Agent he performed a variety of technical, office, and field duties including real estate appraisals and acquisitions, and the relocation of displaced persons for the creation and expansion of the California state highway and public transportation systems. Tens of millions of people traveling across the I-10, 105, and 210 freeways to reach their work, home, and loved ones have Tyrone partially to thank.
Tyrone’s Eternal Loves – Meta, Mark, and Deborah
Tyrone Buchheim met Meta Rothenberg at a dance social at the Beverly Hills Hilton in 1964. A week later they had their first date (a double date) and from then on began a journey that continues on beyond tomorrow.
Tyrone and Meta were married on August 25th, 1968 and honeymooned in Seattle, WA and Vancouver, British Columbia. They enjoyed that trip so much that they repeated it on several other occasions.
Their first residence was a modestly sized apartment; however, they both wanted to expand their relationship and have a family of their own, so in preparation for this future they purchase a home in Mar Vista, CA in 1972. On January 11th 1973, they gave birth to their first child, a son they named Mark and on September 13th 1976 their second child, a daughter they named Deborah, was born.
Together Meta and Tyrone doted over Mark and Debbie. They equally shared in the parenting responsibilities and created a comforting, loving environment. The four of them often spent quality time with other family members and their children, including many vacations and trips to beaches, parks, and amusement parks.
Tyrone’s First Disease: Alcoholism
No one really knows when Tyrone’s alcohol dependence started. What started or appeared to be a pleasant accompaniment to social activities later progressed into what is commonly referred to as “functional alcoholism” which eventually led to the destructive “non-functional alcoholism”.
No one really knows why Tyrone’s alcohol dependence started. His family, friends, and even doctors spent a lot of time trying to understand his addiction. Maybe Tyrone didn’t even know. Some diseases can be cured, some can be lived with, and some can’t be cured at all.
After “retiring” from his job as a Right-of-Way Agent for Caltrans, he never worked a traditional job again. He was an active stock market investor, watched his favorite television shows, karate movies, and westerns, enjoyed walking the family dogs, and loved to find treasure at weekend garage sales.
However, once his drinking got their hooks into him, it was really the alcohol that had control. When the family happiness and living quality was negatively impacted and interventions and multiple treatments seemed to not work…for the sake of herself and children…my mother took action and demanded a separation.
Tyrone Moves Back With His Parents - 1986 to 2000
When my father moved out of the family home and back with his parents I was 13 and just had my bar mitzvah while my sister was 10. Needless to say we were all sad - for him, his parents, and for us. The husband, father, son, and friend that everyone knew and loved seemed to be slipping away.
During this 15 year period the hope that he would beat his addiction became smaller and smaller. The once meticulous Tyrone became messier and messier. He eventually experienced the physical effects of his alcohol dependence: minor seizures, cirrhosis of the liver, removal of his gall bladder, stomach stapling, and ascites in his belly. Despite it all…he always physically recovered. There were periods of sobriety; unfortunately, the grip alcohol had on him would always grip tighter and he would relapse.
During this period, we experienced the passing of both his parents - first, his 80 year old mother Helen in 1987 of cardiopulmonary arrest caused by 20 years of living with Atherosclerosis and next Hyman in 2000 to gastrointestinal cancer, when he was 97. My father was obviously devastated. First, the family he helped create was shattered and next the one that created him was gone. His father really kept him together and we all have great admiration for him for doing so.
My sister, mother, and I would do our best to be in his life during these years. We would be at the hospital for whatever treatments or surgeries he was having. We would visit him at his house or pick him up and go somewhere for a meal or shopping…but it always had a somber tone. We always thought “Is this the last time I will see him alive?” or “Is there anything that can be said or done to change things?”
Tyrone’s on His Own– 2000 to 2011
After the passing of his father Tyrone hit what appeared to be an all-time low. His house had become unsanitary and he had fallen deeper into an isolated state-of-being. We were able to extract him from that environment and place him into an assisted living facility in Santa Monica where he had his own room that would feed him 3 meals a day, clean his clothes and room, and give him some needed structure.
We cleaned up his old, neglected house and sold it…providing him a good amount of saving. He was also doing really well for about a year at his new assisted living facility. We spent a lot of quality time together and there was renewed hope all over again.
Unfortunately, he continued to drink and the facility felt that he would be a liability to other residents and requested that we find him a new living arrangement. They were extremely accommodating and we eventually found a two bedroom apartment nearby where he had a roommate that assisted him with things. We hired a maid to come once a week and even had Meals-on-Wheels deliver food to him on a daily basis. I was extremely active with him during this time; however, the grip alcohol had on him would tighten again, creating an unsanitary environment just like when he last lived on his own and we had to find a new living arrangement again.
At this point, we were extremely frustrated with all the constant pitfalls, moving, and overall saving of his life. The only facility that we found that would accept his alcohol use was 45 minutes north of us in Sylmar, CA. The facility was a little rundown, but he had his own room, was given 3 meals a day, had his clothes and room cleaned on a regular basis, and had some needed structure again.
We all continued to keep in touch. Phone calls and visits out there on weekends for lunches or shopping. He seemed to be more alert and in more control. Even my attitude with him changed. I became more accepting of the way that he was as opposed to wanting him to be something that he might never be capable of being.
Tyrone’s Back Again! – Mid-Oct 2011
My father lived in Sylmar for almost five years and in the last three years had stopped drinking. No one really knows why or how he stopped drinking. I would like to think he finally won. At 73 years old he had taken control and wanted to reconcile with his family again.
He asked for our help in finding him a new, closer living arrangement. Although he wanted to get a traditional apartment on his own, we knew (and deep down so did he) that it would be best to continue with an assisted living facility.
I had just started a project on the east coast that required me to be there most of the week, so all I had were the weekends to search for a new place and spend time with him. After an extensive search, we found an assisted living facility in Culver City – across from the Sony Studios where his father, my grandfather, worked for some time way back when it was Columbia Pictures. It fit his budget, was clean, had availability for him to have his own room, had terrific residents and equally terrific staff, would regulate his morning and evening vitamins and medication, and was only 10 minutes from me and much closer to my sister.
He chose a cozy, shaded room that we furnished with warm furniture, pictures and artwork. Things were looking good again. We were getting our father back and he was getting his kids back.
Tyrone's Second Disease: Cancer – End of Oct 2011
After a few days in his new cozy room he was rushed to the nearby Kaiser on Cadillac Avenue. He was complaining that he couldn’t sleep, was blaming the new facility, and wanted to move back to Sylmar. The doctors knew that there was something deeper, but didn’t know exactly what it was at first. Initial tests showed that he was extremely dehydrated, so they put him on a saline drip. We visited him in the hospital the next day and he was grumpy, loud, and uncomfortable, but then again, having blood drawn every two hours around the clock for four days to test saline levels can’t be too relaxing.
He also had a large belly which was later diagnosed as ascites (the accumulation of fluid in his abdomen) which was relieved by draining two liters of fluid out. Further tests showed that he had a blockage in his kidney which was relieved by inserting a stent (tube) up his urethra.
About four days later he was released from the hospital and returned to his new cozy room at his assisted living facility. A few days later the doctor contacted my mother who relayed some devastating news. During the placement of the stent, the doctors took some tissue and fluid samples to perform a biopsy on. The results showed CANCER.
Tyrone Is Going To Die Soon – Beginning of Nov 2011
I had prepared myself for bad news for the last 20 years, but when my mother told me it was difficult to take. Although I wanted to be strong, I instead felt weak. I was filled with regret, sorrow, and anger.
At first, the doctors didn’t know exactly what form of cancer he had. They detected cancerous cells in the fluid they drained from his belly, so they suspected it was bladder cancer and that it was stage 4. There are only four stages of cancer and this stage meant that it had spread to other organs or throughout his body.
We didn’t know how to tell him. We didn’t know if we should tell him or if the doctor should tell him. We didn’t even know if anyone should tell him because we knew the news would be devastating and we didn’t want to hamper the quality of his remaining life. However, keeping that news a secret was impossible and not moral. He was still sharp as a whip and knew something strong was happening inside him. He had to be told.
Before we could even figure out how to deliver the news he was rushed to the hospital for a second time due to what he claimed was trouble sleeping. He was again dehydrated and had some accumulation of fluid in his belly, so they gave him a few units of saline and draining almost another two liters of fluid out of his belly.
His attending physician was the one who broke the cancer news that he had some form of cancer, that it was at an aggressive stage, and that their prognosis was best case six months. When I saw him after he received the news he was obviously down but he also wanted to fight for his life. Unfortunately, due to his weakened state and the aggressiveness of what we were told about the cancer, there was little chance he could hold it off for too long and no chance of defeating it.
My father was also told that he had a blockage in one of his bile ducts that needed immediate relief which was done by inserting a stent (tube) down his esophagus. After the procedure he was a little confused. He thought it was going to help him fight his cancer. Unfortunately, we had to dash his hopes and re-explain the purpose to him a few times to get things straight.
Tyrone Meets with the Oncologist– Nov 17th 2011
My father, mother, and I met with the oncologist (a doctor who specializes in the study of cancer) a few days later to discuss the details of his cancer. This doctor ended up being very nice, but we had a strange initial impression. After brief introductions he stood next to the room’s computer and quietly typed and clicked for what seemed to be five minutes...as if we weren't in the room.
I was standing slightly behind my father’s right side who was sitting in the padded patient’s chair, my mother was in her own chair just in front of us, and the doctor was further in front of us gazing into his computer monitor and was clicking away. Tyrone then reached into his mouth, pulled out some gum he had been chewing and covertly stuck it on the underside of his expensive examination chair - or so he thought as I was the only one that saw him.
Normally I would make him wrong for an act like that and say something like “Dad…you can’t stick gum under the chair. You have to put it away in the trash.” But as I started to form the word “Dad” he quickly lifted up his same right forearm, outstretched his fingers, and slowly, in an outward sweeping motion, waved in front of me – just like Obi Wan Kenobi with the Jedi mind trick…or back in his magician days ("Now you see it. Now you don't.")
My father broke the silence in the room – “Doc…give me the bottom line!”
He had pancreatic cancer. It’s the fourth most common form of cancer. It’s called “the silent killer" because it often does not cause symptoms and later symptoms are usually nonspecific and varied. Therefore, pancreatic cancer is often not diagnosed until it is too late.
No one wanted to take his fight away but the doctors would not agree to any aggressive surgery or chemotherapy as he would never survive those options. What my father accepted was a light 30 minute dose of chemotherapy four times once a week – three weeks on, one week off, then one more week back on. We scheduled his first treatment the following Monday.
Tyrone’s Chemotherapy Treatments – End of Nov to Mid-Dec 2011
I reached out to a friend whose husband was undergoing aggressive chemotherapy and radiation. She eased my concerns over the light doses of chemotherapy my father would be receiving. She also mentioned something called palliative care, which is a specialized area of healthcare that focuses on relieving and preventing the suffering of patients. So I started to look into that too.
I was still conflicted over the choice to do the chemotherapy. First, the hospital visits alone take a lot of time – time away from other enjoyable activities. Second, the environment at the hospital and especially the oncology department can be depressing. Third, there was a lot of needles and blood drawn – every time before chemo to test his white blood cell count and the two hours later during chemo if everything was good. Sometimes we would stay longer on days where he would require an additional unit or two of saline – requiring another 1.5 to 3 hours. And fourth, it could weaken him – reducing what quality of life he and we had left.
In addition, we filled out an advance health care directive, which is a document specifying what actions are to be taken for his health in the event that he was no longer able to make decisions due to illness or incapacity, and appointed me, my mother, and sister to make such decisions on his behalf. We then gave this form to Kaiser for their records. My father’s basic instructions were to not resuscitate him due to what might result in an uncomfortable quality of life from some evasive recovery means. The same instructions applied towards nutrients. We also found out that these instructions can also be a part of most living wills, which he did not have
Spending Quality Time with Tyrone – End of Nov to Mid-Dec 2011
Right about the start of his treatments, I was finishing an important phase of a project that I was working on back on the east coast. My project’s management and team members were extremely accommodating and supportive. For a period of two weeks, right around Thanksgiving, I was able to continue working from Los Angeles – sometimes at my home office or even at my father’s place. I only went back east for three days to close out some loose ends and returned back to LA for good.
We wanted to bring as much joy to my father as possible, but more importantly represent how generous he really was - he would give the shirt off his own back to make a friend. The night before Thanksgiving my wife, Tatjana, and I placed small house plants on the doorsteps of all the 110 residents at his living facility (and 30 more for the staff). Each came with either a funny Thanksgiving joke or thankful saying – all addressed from Tyrone. We delivering my father a special note under his door telling him how much he was loved, that we knew he loved us very much, and that we were sharing that love with everyone at his place by giving them all gifts at their doorstep in his name.
Unfortunately, he did not read the note on his way to breakfast the following morning and was a little confused when dozens of people thanked him for his unknowing generosity. Later in the day we explained everything and from then on he was gladly accepting everyone’s warm accolades…although he would redirect the all the credit to his son. Later in the week he was showered with thank you cards and notes that he displayed around his room. We all got to know many of the residents and staffers at his residence and we would often spend a lot of time with them – they were all very concerned for my father.
Tyrone was spending time with everyone. My sister came into a more flexible schedule, allowing her to spend more time with him. She even visited him with her two young daughters – the first meeting between him and her youngest, Paige. My mother was always involved with his life and during this time as well. She would help with taking him to doctors’ appointments when I was not able to or just to relieve me or to do some errands for him. Tatjana was also extremely supportive during this time, discovering how much this man meant to me.
All of the past regret and anonymity was gone. As best we could due to the circumstances we were enjoying our time together and appreciating being present with each other. Of course we spent a lot of time at his place and at the hospital, but we also experienced much more. We visited the Aquarium of the Pacific, toured the grounds at Lake Shrine, shopped at the Grove and the old Farmer’s Market, walked around swap meets, and went out to several restaurants. We drove through all his old neighborhoods, up and down the Pacific Coast Highway, and several other scenic Los Angeles landmarks.
My mother told me that one day, while they were just sitting peacefully on a bench, he expressed his remorse about how his alcohol dependence affected everyone’s lives and that he was proud of everything that she had done to continue to raise their children. He appeared to be a different person.
He was extremely proud of my sister and me and would let anyone who would listen to him know it. It seemed as if everyone whom I met at his residence already knew me. We meant the world to him, but it wasn’t until his world began to slow down for this love that once was bountiful to appear again.
Tyrone’s Showing Signs of Decline – Nov to Mid-Dec 2011
Going out with my father required a lot of preparation and attention. He was having trouble maintaining his balance and endurance, so the use of a four wheeled walker helped. We would just have to pace ourselves by going slow and taking breaks, but we would be able to see everything that we wanted.
Even tasks like turning on and off the television and cable box became challenging for my father; however, most remote controls are confusing. In order to make things easier, I purchased him a simplified universal remote that only had a few buttons with the hope that it would be more understandable. It did make things easier; however he continually needed to be shown the process. I had to create several large font instruction sheets for him, but it seemed like we needed to review it daily. It was painful for me to see him struggle with something that he enjoyed – watching TV.
We were looking for more assistance for my father so we contacted Kaiser and asked about this palliative care thing. If you've never heard of palliative care, you're not alone – most people are unfamiliar with the term. More people have heard of hospice care, but even that service was not clear to us, we definitely didn’t understand the difference between that and palliative care, and didn’t understand when and if that would be appropriate, and whether they would perform or allow that service at his assisted living facility.
In addition, either due to his declining health and possibly the chemotherapy, he was having trouble going to the bathroom. Like many seniors, he had taken to wearing adult diapers; however, he had what could only be categorized as explosive diarrhea - unfortunately, he would not always make it into the toilet. In order to alleviate some of his discomfort we tried Imodium, an anti-diarrhea mediation, and although he said it helped it didn’t work 100% of the time. There were several occasions when we were out that required spot cleanups on his clothes and only a few that required a more evasive washing.
At first Kaiser declined to provide palliative care because they said he was still able to get out and walk without assistance from others. Eventually they agreed to offer him this care and scheduled an intake nurse to come over. They performed some basic vital sign tests and had us fill out a one page form that we displayed near his bed that outlined his wishes as it relates to resuscitation and nutrient feeding. There were a few follow-up visits by palliative care nurses, but they said they would only come out a maximum of two times a week, so we still had to monitor my father’s condition closely on our own.
Tyrone’s Last Chemotherapy Treatment – Dec 19th 2011
Like each of his chemo treatments, the hospital required a sample of his blood drawn in order to test his white blood cell count. This part of the hospital is simply referred to as the laboratory. At his hospital it was located in a small room in the basement and it would go through periods of emptiness to what looked like a midnight madness sale at a Wal-Mart; however, most of the people in line were aged or sickly. We would pull off a numbered ticket out of what was like a deli counter dispenser and stood in line. Normally when you get up to the reception desk they would check you in, ask for any payments, and tell you take a seat to wait for your number to be called. However, due to my father’s health condition and subsequent appointment schedule he was always placed at the front of the line.
My father, mother, and I were on our way from the laboratory where he drew blood to test his white blood cell count to the oncology department upstairs. As we were wheeling him around on the hospital supplied wheelchair, as he was no longer able to walk with his walker for long distances, we noticed a strong fecal odor. We went into the bathroom stall together, like we had been accustomed to in the last few weeks, and noticed he had a big accident. Since he still had all his mental faculties, he was both pragmatic and embarrassed during these accidents. It was sad but I always comforted him and let him know that I was there for him, that it was okay and that he should not be embarrassed, we were going to get cleaned up, and we will move forward together.
When we went out we always prepared ourselves with extra diapers and wipies, but we didn’t have an extra pair of pants. So, with pants off and gloves on, I had to perform a deep cleaning in the bathroom sink. He was cleaned up, his shoes and chair were cleaned up, the floor was cleaned up, and with a fresh pair of underwear and a damp pair of cleaned pants we headed to oncology.
My father’s last chemo treatment was bitter sweet. On the one hand, we were there to potentially hold back his cancer for as long as possible and there were so many nice people whom we have gotten to know and so many of them got to know my father. On the other hand, this was the end of one stage and the start of another - a decline one.
On the way out I had spoken to his oncology doctor about the troubling bowel movements that my father (and I to some extent) were experiencing. He told us to go back down to the laboratory and request a stool sample be taken for analysis. Of course, now is the time when my father doesn’t feel like going to the bathroom, so they give us a take home kit with a container and tiny scooper thing.. We really wanted to figure this out as soon as possible and provide some relief and comfort to him, so I had an idea as we were wheeling out and passed the bathroom where I changed his diaper in just an hour prior. I turned to my mother who was holding the stool sample kit and some extra sanitary gloves and said “Give me the kit and gloves and watch dad. I’ll be right back.”
You don’t know what you don’t know. At that moment, like thousands of other moments, I learned that my love for one thing (my father) and my hatred of another (his discomfort) made me capable of things I never imagined doing.
Tyrone’s Last Hospital Visit – Tuesday, Dec 20th 2011
The results of one of his last blood tests showed that he required a blood transfusion. They wanted him to receive two units (bags) which we were told would take about three hours’ time – instead…we were there for about seven. Due to his declining health, it was increasingly difficult to find a usable vein in his arms. On some occasions he would be poked up to seven times. Hospitals typically have a policy that if a nurse fails twice to find a vein, then they have to have another nurse take over and attempt anew. Eventually, they started using veins in his hands, which is a bit more uncomfortable.
One way to pass the time and make him comfortable during his hospital visits was to play classical music on headphones via Pandora on an iPod using the hospital’s guest access Wi-Fi. My father loved to listen to classical music. It brought him to his happy place which comforted me as well.
Ultimately, this was a difficult and draining day for both of us. I saw a lot of sick people, a lot of sad people, and a lot of tears. My heart was getting heavier and heavier.
Tyrone Has Energy – Wednesday, Dec 21st 2011
A day after the transfusion, my father seemed to be in good spirits and have some energy. After spending some time with him at his place he wanted to get out and go to the market to pick up some food. We went to a local Sprouts and he was hard to keep up with. He was darting through all the aisles and was throwing items in the cart that I was pushing behind him. Later we went back to his place and watched old episodes of MASH and Bonanza on TV Land – two of our favorite shows. He had an appointment the next morning with his primary palliative care nurse and I reminded him of that several times before leaving that evening.
Tyrone Can’t Get Out of Bed – Thursday, Dec 22nd 2011
The next morning I enter my father’s room about 15 minutes before his nurse was expected to arrive. However, instead of seeing a well lit room with either music playing or the TV on with my father dressed and ready for the new day…he was still in bed and what appeared to be in deep sleep. I nudged him and he awoke and said “I don’t know what happened. I must have fallen asleep.” I replied back “Yeah…it looks like it. We need to get ready for your appointment with the nurse in a few minutes.” He repeated…“I don’t know what happened. I must have fallen asleep.” – again, and again, and again – about 30 times like a skipping record.
The nurse eventually arrived and evaluated my father for his vitals and his comfort level. My mother also came over shortly after. His blood pressure was dropped from around 140 over 70 to 85 over 60 and his heart rate was overcompensating at around 125. Although my father was able to state that he wasn’t in any pain, he couldn’t get out of bed, mostly kept his eyes closed, and spoke mostly when spoken to and in short bursts. The nurse told us that this was the start of another declining level and that she was prescribing him morphine for pain control…if not for now, then for the future if he needs it. She eventually left and we were on our own.
Although I was on all of his bank accounts, we filled out a power of attorney, which is a document that gave authority to me, my mother, and sister to make decisions for my father regarding his finances and legal matters. In California, two witnesses or a notarization is needed in order to validate the document, so two of the staffers at the assisted living facility came up stairs to fill those roles. It was at that point that his declining health was truly revealed to the facility.
I spoke to the assisted living facility about extended care giving but due to their limited non-medical staff they were only able to provide checkups on residents every 2 hours or so. We were referred to a few different private caregiver services. Some charge hourly, around $14 per, and some charge for an entire 12 hour shift, around $125. We brought in the one that would provide a 12 hour overnight shift (7 pm to 7 am). They changed his diapers and sheets (if needed), gave him drinks, gave him vitamins and other medication (mostly a once a day thyroid pill and an as needed Vicodin), and provided human comfort and companionship.
My father had also developed a few stage 1 and 2 bedsores near his tailbone – there are four stages. Stage 1 is merely a reddening of the skin, but a stage 2 is a skin abrasion, much like a popped pimple. I remember a staffer at the assisted living facility mention that if a resident develops a stage 3 bedsore, then they might have to transfer to another facility, such as a convalescent home. Before leaving, the palliative care nurse applied special medicated bandaged to his sores and said that we wouldn’t need to change them for a few days.
We wanted to do everything to keep my father in his own comfortable room and not go through the pain (for him and us) of moving him into and staying at a depressing convalescent home. In order to prevent the onset of new bedsores and to reduce the aggravation of his existing ones, he would need to be turned to alternating sides of his body every two hours. This was something that the private caregiver helped with at night. I stayed with my father and the caregiver until late in the evening and then I left for my home to get some rest for the next day.
Tyrone Starts to Withdraw from this World – Friday, Dec 23rd 2011
The next morning he was even more catatonic. I saw that the private caregiver managed to change his t-shirt, which must have been uncomfortable for him based on how much he would grimace when his body was turned every two hours. Unfortunately, it was taken off and on like a normal shirt. In a bed-ridden state, it is suggested to cut the entire back so that it is more like a hospital gown and slips on and off easily.
I received a phone call from my wife on her way to her work. She asked how things were going and although I had done my best to describe his declining health across the previous two days it just couldn’t be visualized accurately. She detected that something must be really bad. She asked me a few more questions and if I needed help…but I just couldn’t answer. It wasn’t that I didn’t have answers, but instead that I was just too emotionally choked up and exhausted to do so. She said that she would notify her work that she wasn’t coming in and instead come over to my father’s and help.
Tatjana was an extremely helpful part of the process. Although we have been together for more than 16 years (15 of which married) she was able to act in a much more pragmatic manner than the rest of the immediate family (although my mother is extremely strong as well). Tatjana became the primary communicator between us and the outside world, whether with the facility where he lived, the private caregiver agencies, or palliative care.
She was absolutely shocked as to the condition my father was in. The last time she saw him he was active and talking and now he was mostly catatonic. She also went to the pharmacy and picked up some morphine that was prescribed to my father a day prior. We were never shown how to administer the morphine and at first we thought the instructions called for it to be administered rectally. She contacted palliative care and they dispatched the primary nurse whom we had been dealing with.
The nurse eventually arrived and took his vital signs and discussed with us what she thought was happening. Because my father was still able to hear perfectly well we moved our conversation to the hallway. She told us that his body is shutting down and that he needs to be administered the morphine, a low 5 mg dose up to every 4 hours if he experiences any pain or discomfort – orally through a dropper, not rectally. She also said that if he doesn’t want to eat or drink, which he hadn’t for the last two days, then don’t force it on him. Due to his current stage his body would not process any nutrients, including an IV drip, and instead fluid would build up throughout his body causing even greater discomfort. None of this was making complete sense, but we were going along with the instructions.
She also said that a more comfortable hospital bed could be delivered. Since my father’s breathing became more of a challenge for him the controllability of the bed position would help. It would also have a special mattress pad to help alleviate and avoid bedsores. I also brought up what appeared to be his difficulty breathing. She said that he was low on oxygen in his system and that she could order an oxygen tank to be delivered as well.
She told us that she was leaving for the Christmas weekend, that she was going to check in with us when she is back next Tuesday (four days later), and that if we needed any further assistance to contact the main palliative care number. She eventually left and we were on our own again.
During the day I changed my father’s diapers and sheets, turned him every two hours, tried to give him sips of liquid, administered his Vicodin, held his hand, touched his head, gave him kisses, reminisced about the good ‘old times, and told him how much I and we loved him. Since my father was a 5’ 10” and about 155 pounds, the caregivers that were part of his assisted living facility would sometimes help with his diaper changes and body shifting. Since he was no longer opening his eyes and could really only hear I played classical music on a low volume constantly. It seemed to really sooth him (and me).
Eventually the hospital bed and oxygen tank arrived and with the help of his assisted living facility staff we were able to move him onto the new bed. I dismantled the old bed and moved it out of his room. The oxygen tank used a delivery system that was placed directly under his nostrils, but he didn’t like it, so we never used it again.
We contacted the private caregiver service again for some relief at night. Again, I stayed with my father and the caregiver until late in the evening and then I left for my home to get some rest for the next day.
Tyrone Is No Longer Speaking – Saturday, Dec 24th 2011
Everyone arrived early at my father’s - me, my mother, sister, and wife. We all took turns trying to comfort him with sips of liquid, holding his hand, touching his head, giving him kisses, reminiscing about the good ‘old times, and telling him how much we loved him.
We knew he was still with us. We were repeatedly told by doctors and nurses that the hearing was the last sense lost in the dying process. When he heard how much we loved him and that we knew how much he loved us – he smiled. When he heard our stories about all the fun trips and experiences we had with him – he smiled. When he heard how his indelible fingerprint he left on us and the world will be treasured forever – he would smile. Occasionally, he would even have enough strength to squeeze our hands back when we were touching his in response to one of our memories of the good times.
My father did not make any plans for his after death needs. However, he had always said that he wanted to be buried and be near his parents, which were laid to rest in the Jewish Beth Olam mausoleum at Hollywood Forever Cemetery in Hollywood – directly next to Paramount Studio. He didn’t want to be cremated because that was frowned upon in the Jewish faith.
The previous day, Tatjana contacted Hollywood Forever and received a bunch of options related to cemetery and funeral services. The earliest appointment she could make for us was the following day. While my sister comforted my father, my mother, my wife and I visited the cemetery and discussed his after death wishes. We chose a traditional pine casket (made without nails), a crypt near his parents, and a simple Jewish service. She showed us the location right on the other side of the wall where his parents are located. It’s a new section they built that is outdoors. Unfortunately, due to the Sabbath, they close off access to the inside of the mausoleum, so we could not visit my grandparents. Overall, the total costs ran nearly $13,000.
We contacted the private caregiver service again for some relief at night, but this evening I was not able to leave him. I had to comfort him like I thought only I could. Even though the caregiver was there, I could not rest assured. I was listening to my father’s breath too intently. I was up all night.
At one point, he had a lot of sound coming from his throat. I recalled there was a prescription for some drops, Atropine, which would help him in the event that he had this “gurgling” sound, but we didn’t have it in our possession. I didn’t have my car since my wife dropped me off, so I called her at 2 am to pick me up so we could go to the 24 hour pharmacy to pick it up. It seemed to work. A few drops under his tongue seemed to help dry things up and the sounds went away.
I made sure he was able to hear his favorite classical music at a soft volume from a nearby set of headphones (because wearing the headphones was uncomfortable for him). I administered his morphine and sleeping medication and touched him constantly…letting him know it was me. It was the most difficult night of my life, but knowing that I was providing him comfort gave me the strength to endure.
Tyrone’s Strength and Love – Sunday Morning, Dec 25th 2011
The next morning, after the caregiver left, I waited for the arrival of my mother, sister, and mother. I went over to my father’s bedside where there was a chair that I would typically sit in for extended periods of time. I wanted to tell him it was me so I elevated the back of his bed a bit, stood over him, held his hand, and told him it was his son Mark. He opened his eyes for the first time in days, stared directly into mine, said “I love you”, dug both his elbows into his mattress and mustered enough strength to push his frail body away from the bed and kissed me directly on my lips. He then fell back down to his mattress and closed his eyes.
I was in complete shock. It felt like a supernatural experience, the first of two. I was in a moment of hysterics and grabbed my nearby video camera to try to capture more. Unfortunately, he had gone deeper into his other world.
I want to believe he had saved up all his strength through the night just for that moment. Seeing his condition leading up to that point shows how physically and mentally difficult it was for him to perform that act of appreciation and love.
We All Need Help – Sunday, Dec 25th 2011
My father’s condition was noticeably getting worse. In addition, all of our conditions were getting worse too. Monday was a holiday, but we didn’t know how to continue providing him support and comfort on an ongoing basis. Sure we could hire more private care givers, but I wanted to be there for him and I couldn’t let go of that. My family demanded that we look into it though.
We didn’t think that the caregivers that we hired up until now for evening relief would be able to provide him the round the clock care that he would require, so we contacted palliative care again. They referred us to some more agencies; however, due to the Christmas holiday weekend they were not able to dispatch anyone out for a few days.
We kept on going back and forth on the decision to either keep him in his comfortable room or disrupt that and move him into the uncomfortable, cold, noisy, and sterile environment of a convalescent home. We also had an option to move him into the hospital for up to five days; however, we chose to continue providing him his comfortable environment to the best of our abilities.
My father started to grimace in his face more often and we didn’t know what to do. We called palliative care again and described what we were observing. Miraculously, they were able to dispatch a nurse later in the afternoon. Her name was Susan and she was amazing. She had the same role as our other primary palliative nurse; however, she had a different delivery and approach that made more sense and provided us greater comfort.
With her British accent she let us know that everything going on - his decreased state, his more belabored breathing, and his increased pain - were expected parts of the dying process. She took his vitals (now around 80 over 60 and still with a 125+ heart rate), changed his diapers, administered his pain medicine, and called the palliative care on-call doctor to discuss moving forward treatment options. What was devised was an intricate cocktail of medicine that would be administer around the clock to help easy his increased discomfort: a higher 10 mg dose of morphine every 6 hours, his once a day sleeping pill would be dissolved in water and given to him every 4 hours, and if there is excessive gurgling, more Atropine drops.
She also made us read a pamphlet right in front of her called “Gone From My Sight: The Dying Experience” by Barbara Karnes, RN. There is something about those words that made everything seem more acceptable. There were some hard to read parts, mainly a detailed description of the last weeks, days, hours, and minutes of a dying person’s life, but that is what we needed. We needed to be aware of those things and be prepared for when they occur.
This was it. He was really dying and we were more prepared. I don’t think you could ever really be prepared, but somehow those words and Susan’s comforting assurance that this is "normal" made it easier.
She also demanded that I stop being his primary caregiver and go back to being a son. It was difficult and sometimes looking back I don’t necessarily agree that it's that cut and dry, but we had another caregiver help through the night, albeit with the higher barrage of medication to keep him sedated longer and pain free. We all stayed with my father and the caregiver until late in the evening and then left for our homes to get some rest for the next day.
Goodbye – Monday, Dec 26th 2011
My sister was the first to arrive at my father’s bedside. She notified me that his gurgling has gotten a bit worse, so I got ready and hurried over as soon as I could. In the meantime, Debbie recalled that we were talking about having a Rabbi come over and read the Shema, the most central prayer in Jewish life. It is traditional for Jews to say the Shema as their last words. If unable to do so, then the family and loved ones can do so for the soon-to-be departed.
We did not have a family Rabbi, so my sister took to her iPhone and searched for one. The first one to catch her eye was Rabbi Barry Tuchman. She explained the situation as best she could to the Rabbi and although he typically only performs weddings, he could not refuse.
My mother, wife, and I arrived and awaited the Rabbi’s arrival. He arrived just as he promised, at 11:30 am. We expressed our gratitude for coming and gave him a little preparation for what he was about to witness behind my father’s Room 228 door. He also saw the pain and anxiety in us and did his best to comfort us. “Death is not the opposite of life, but a part of it.” he said. He said several things before entering my father’s room, but that is what I held onto and gave me strength.
We all walked in and my father was still catatonic and breathing a bit heavy. The rabbi was noticeably taken by my father's state and had to compose himself before moving on. It was at this point that my wife was too affected by what was going on and left the room. I went over to my father, touched and kissed him and told him we were all here and we’re going to try to make him comfortable. I had administered his sleeping medication earlier but due to his gurgling I also gave him some Atropine drops. He seemed to grimace a bit so I also gave him another dose of morphine and we did our best to adjust his body and head so that he could breathe as easy as possible.
I placed a yarmulke onto of my father’s head, held his hand, and Rabbi Barry introduced himself. “Hello Tyrone. I’m Rabbi Barry Tuchman. I’m here with your family – Mark, Meta, Debbie and Tatjana. We are here to help bring you to a place where you can be complete and you can make your transition.”
All of a sudden my father’s eyes opened as wide as they possibly could and he started to gurgle even louder. Although the amount of medicine in his body should have sedated him, he was wide awake and with us in this moment. This was supernatural experience number two.
Rabbi Barry then read the Viduy, which is a Jewish confession, much like the last rights in Christianity. The idea behind the confession is that the soul should be pure when it returns to G-d and by reciting this prayer and repenting you will evoke G-d’s mercy.
“This is a moment of atonement for you my friend. This is a moment when your sins are forgiven and you are at one with G-d.” Rabbi Barry said to my father after reading the Viduy. Unfortunately, my father’s gurgling and movements was too much for my sister to handle so she ran out of the room.
Even though this must have been extremely difficult for the Rabbi, he pushed forward and read the Shema. “Hear O Israel, the Lord is our G-d, the Lord is One.” My mother and I followed with some blessings in Hebrew. Rabbi Barry continued with his blessings and then…we were done.
We sat at his bedside for about 2 more minutes while we saw him struggle to enter back into our world until he closed his eyes and fell back into his other world. I was able to then position my father a bit more so that he could breathe easier and he became much more steady and relaxed. The Rabbi first left the room, then my mother, then me. My father was left alone for about 5 minutes. The Rabbi re-entered to pick up his belongings and then left. My mother entered to get something out of her purse, she checked on my father, and then left. I entered his room to check on him and then left. It’s 12:10 pm. Tyrone Buchheim has passed away.
Death is a unique experience for the dying and for the grieving. It comes at its own time and in its own way. I believe my father held on until his loved ones gave him permission to move on and he was given the opportunity to be relieved of what people might call "their worldly sins".
I believe all people have a foundation of goodness and decency, if properly sought, and although my father had some undistinguished characteristics that caused others discomfort or pain...an objective view would reveal a gentle, giving, intelligent, and humorous man.
The last few months and days were both difficult and beautiful. My sister and I are his legacy. His beautiful grandchildren are his legacy. Although it's common to wish that the past could have been different or "better" and to say "why us" or "why him"...I choose to say "why not us" and "why not him". We are the gentle, giving, intelligent, and humorous children and adults we are today not in-spite of our experiences but because of them.
I am standing upon the seashore. A ship at my side spreads her white sails to the morning breeze and starts for the blue ocean. She is an object of beauty and strength. I stand and watch her until at length she hangs like a speck of white cloud just where the sea and sky come to mingle with each other.
Then someone at my side says: “There, she is gone!”
Gone from my sight. That is all. She is just as large in mast and hull and spar as she was when she left my side and she is just as able to bear the load of living freight to her destined port.
Her diminished size is in me, not her. And just at the moment when someone at my side says: “There, she is gone!” there are other eyes watching her coming, and other voices ready to take up the glad shout: “Here she comes!”
And that is dying.
- Henry Van Dyke