Written by Iatros Polygenos
I know that a lot of people know by now, but I needed to write it out again. Jeff Medkeff died August 3rd, 11:05am at Queen Elizabeth the Queen Mother Hospital in Margate, England.
One of the last things that was said to me was a request to post a blog. I didn’t realize how hard it was going to be to sit down and write about the things that have happened. I just realized today that it has been one week since Jeff died, and that it was time that his request should be upheld.
Jeff never let the diagnosis get him down. He kept pushing forward in trying to find someone who could treat the cancer, while all the time knowing the chances were slim. When it became evident that there was no major treatment available, he decided to start the oral chemotherapy, Nexavar. Unfortunately, he came back from MD Anderson with a nasty upper respiratory infection and couldn’t start the chemo until that was cleared up.
Early on after diagnosis, he said that he wanted to go to England to see some of my family. He still wanted to do this and so we planned to go after returning from MD Anderson. The doctors all told him that he was fit to fly. He seemed to be in pretty good spirits about everything. So, off we went to England. Our flight went over the pole and landed in Frankfurt and was a fairly smooth flight. There was a day layover in Germany and the flight left from the Frankfurt Hahn airport. Traveling has been pretty uncomfortable for Jeff, so the bus ride to Frankfurt Hahn was not something that he enjoyed.
My brother had requested a list of things that we wanted to see while over here. One of which was Westminster Abbey, to see Charles Darwin’s grave. There was a pleasant surprise when we arrived however. Charles Darwin’s House – the Down House – is located on the south side of London. Jeff had thought that is was north of London. Since we were staying in Deal, that made it pretty easy to visit. I think that the visit to this house as well as to the Royal Observatory in Greenwich were the highlights of the trip for Jeff. At the Down House, Jeff picked up a book to write his thoughts about his trip.
Some of his thoughts on the Royal Observatory are as follows:
R.O was largely as expected, being very much like its pictures. The camera obscura, which was trained on the Naval College, was impressive…Piece of Wm. Herschel’s large scope was sitting in courtyard; had my picture taken with it. Very nice to see the transit instruments, which essentially founded my field of astronomy (astrometry).
The same day we went to the Down House.
Down House was a great pilgrimage. It is a large, but not huge, country house on the outskirts of London. Presumably it is Regency in origin? It looked v. comfortable and I envy Darwin his opportunity to spend years there reducing the Beagle data. I walked the Sandwalk and visited the greenhouse as well. Was impressed that Darwin was so well-instrumented for the Beagle voyage – including clinometer, barometer, magnifiers, etc. Most accounts of Darwin in the Beagle years that I’ve seen depict him as more of a specimen collector, rather than as someone also doing quantitative work.
Darwin is huge, personally and scientifically. It is remarkeable to think that his theory predicted genetic mechanisms of inheritance. But the cultural impact was also large. On a personal level, Darwin makes it possible to view my disease not as the result of the actions of some despicable god, but rather as a predictable and impersonal consequence of the way my species came into being. The universe, along with its “creator” or universal personality, or whatever, is not out to get me. The universe isn’t capable of being out to get me or anyone else – it hasn’t got the necessary attributes to do so. This is an impersonal problem. That’s very comforting, far more so than thinking that there is some shy ghost fucking with people in senseless, cruel ways.
We visited these two places on the 25th of July. We were taken all over the place looking at Roman ruins, Roman painted houses, Canterbury Cathedral (which he had some very scathing things to say about, especially since it was crawling with Bishops at the Lambeth conference)and also the British museum, where he was thrilled to get up close to the Rosetta stone.
He was doing very well during this time, walking and feeling quite hungry(he got an inexplicable craving for McDonald’s once). He had also started taking the Nexavar and had no side effects that he could discern. The only problem was trying to time things right. He was eating small amounts all during the day. The Nexavar was supposed to be taken 2 hours after eating and one hour before which required some timing and usually happened after breakfast but before lunch. The chemotherapy was started very slowly and was going to be worked up to the full dose of 2 tablets twice daily. It was going to start at one tablet daily for several days, then one twice daily and so on. He only got to take 2 evening doses.
On July 30, we toured Walmer castle(if anyone goes there – don’t listen to the tape. It was awful) and then had some drinks on the beach at the Zetland arms. Everyone was in a very good, mellow mood. In fact, while on the beach, my brother found a fossil that Jeff was looking forward to identifying when we returned from England. It wasn’t until dinner time that things started to get bad. Jeff was only able to take one bite of dinner and then after we finished, started to get nauseous. I thought that it might be side effects from the chemotherapy. As always, when offered some antinausea medication, he looked it up to make sure it was compatible with the loads of medications that he was taking. Unfortunately it did react with the medication to lower the calcium, so he had to settle for plain soda water. This seemed to help and he felt better quickly, but was extremely tired. He was also uncomfortable and was hoping that some hydromorphone and laying down would take care of the problem. At around midnight, he woke me up because the nausea had returned and he needed help to get to the bathroom. That is when the vomiting of the blood started. Earlier in the evening, he told me that he was concerned that if he did any vomiting, that could start the enlarged verices in his esophagus bleeding. What we didn’t know at the time was that the verices had already started bleeding and that was what came up. It is hard to say when or why they started to bleed, but I would expect that they had started earlier that evening. We are unsure whether the tumor had gotten bigger, causing more pressure on the portal vein.
We went to the hospital by taxi. As it was explained later that sometimes getting a taxi was quicker than getting an ambulance. It was interesting once we got to the hospital, since they weren’t that busy. They nurse handed Jeff a hospital gown and had him change and then just left him sitting on the gurney for a short time. I went off to find a container and he vomited blood again. At that point several doctors came running and decided that he was now someone to pay attention to.
I do admire Jeff for the way he handled all the discomfort he was put through initially. They put 2 catheters into his arms without a problem, but then another doctor came up to take over and advised him that they needed 2 other bigger catheters going as well. They had to try several times before being able to get those in as his blood pressure had dropped to 72/24. Yet he was still totally coherent. He even asked if he could get up and use the restroom. The doctors looked shocked and told him that they were afraid he would faint if he tried to get up.
During all this time, they were assembling a team to scope his esophagus and stomach and try to band the bleeding vessels. They were able to get him down for scoping by 9 the next morning. The team was trying to decided if they should just lightly sedate Jeff or if full anesthesia should be used, when Jeff vomited on the surgeon. He decided full anesthesia was needed. (We had planned on going to the National Gallery in London this day). I don’t remember exactly when they finished with him, but it couldn’t have been before noon. They said that they had been unable to put bands on them as they first had hoped, but they injected all the ones they could with a substance that would seal them off. The doctors told me that the verices were severely engorged, which was different from the scoping 3 weeks previously. Even with all the injections, they were unable to get all the bleeding stopped and the vessels were still oozing. They had placed a sanstocken tube into his stomach and inflated balloons on the tube to put pressure on the stomach and esophagus. Then this tube exits the mouth and they hang a weight to help with the pressure. While this tube is in, he was anesthetized and had a ventilator.
The staff would leave the weight on for 3 hours and then take it off for 2. This was kept up for the next 24 hours. When I got back from breakfast on the 1st, he had just been woken up and was soon extubated(the breathing tube was removed). The staff were quite surprised that Jeff was so calm and didn’t try to rip out the tubes. I was told that a good proportion of people coming out of anesthesia are frantic and try to remove all stuff from their bodies. I could tell that he was uncomfortable with the sanstocken tube, but he still had some drugs on board, making it bearable. They couldn’t take that tube out until late afternoon. He was certainly happy when they were able to remove that, but he said it was extremely uncomfortable. In fact, later he would start to doze and then remember them removing that and it would startle him awake. Also, his swallowing was screwed up for the night. He said it felt like he swallowed up. One doctor was talking about placing a feeding tube, but he said that he couldn’t swallow it, so they didn’t follow through with the feeding tube. They were able to get the nausea under control and finally the pain was also well managed. They always listened to us when told that he does not respond to morphine. They never tried to give him morphine and went straight to the fentanyl, which he responds to very well.
After the sanstocken tube had been removed and several hours had passed, it was evident that he was continuing to pass some blood. At least he wasn’t vomiting it up anymore. The doctor which had performed the scoping, came back and wanted to re-scope Jeff and possibly put the sanstocken tube back in place for a little time longer. We had discussed the issues and then asked some questions. One of which was the likelihood of Jeff walking out of the hospital after the procedure. The doctor said that the chances were less than 50%. At that point, it was decided to just continue with palliative care and not do any heroic measures. He wanted to live out the rest of his time in comfort and dignity and not with tubes everywhere.
August 2nd was a very good day for him. He was talking softly and joking around with all of us. The pain was under control and he was drinking water and really enjoying a strawberry protein shake. Even some of the nurses were thinking that during the week he would be moved to one of the wards. One of the medications that they were giving him was supposed to tighten up the vessels and it appeared to be helping. During that night, he was given a sedative to sleep and was very happy when I left to get some sleep myself.
The next morning, as I got ready to return, the nurse called and said that he had started to breathe differently and suggested I come in. When we got there, he had passed a large amount of blood and was stretched out, breathing deeply and was not responsive. I have been present for lots of deaths ( I know, animals, but they die in a similar fashion) and this was one of the smoothest deaths I have seen. He just gradually slowed down, until his breathing just stopped. He was in such good shape with the rest of his body that his heart continued for another 5 minutes. And then he was gone
So, we have lost a wonderful person. Someone who fought for better education and loved to teach kids himself. I know that I will miss him. Somehow, everything seems a little smaller.