Valentine for Irene and Jim
Irene was in her early 70s when she was diagnosed with vulvar cancer. Jim, her husband, was a sweet and kind man, who took care of his wife with genuine devotion as she became increasingly disabled. As their local gynecologist, we saw each other frequently, and Jim always listened carefully, and obviously gave a lot of attention to the kind of perineal hygiene which was needed. Over the years we worked out an elaborate regimen of soaks and tissue protection to try to help the skin and tissue from breaking down. She had had a radical vulvectomy, and then radiation treatment. There was no local pain, but it was difficult to keep this area clean and dry, and to keep toilet functions from breaking down the area.
Once on Thanksgiving day they had to come to the Emergency room for catheterization, because the tissue changes had made voiding impossible. It was difficult for me to place a urinary catheter—because the tumor had started warping the soft tissues, and the radiation changes had made the flesh stiff and fragile. Sweating with relief as the urine started to drain into the foley bag, I could see their faces soften with relief as well. We joked about missing the turkey dinner to get this catheter in.
They understood the diagnosis and the prognosis, and were remarkably in tune, giving each other emotional shelter whenever possible. Irene often spent much of her visit with me worrying about Jim’s heart condition. Jim always turned attention from himself, and insisted that hers was the harder cross to bear.
Sometimes after they left, I would just sit with tears in my eyes, thinking of the love that he showed by carefully and gently keeping her vulva clean and intact. This tissue, the doorway to women’s sexuality, the symbol of love and lust, was distorted and invaded. There was discoloration, and small bleeding points from raw spots. It was impossible for any kind of sexual activity to occur, and the radiation had left the area numb. I am glad it was numb, and not in pain, but it made it hard for Irene to evaluate whether it needed care. Jim’s careful ministrations were a deeply meaningful reminder of the real meaning of love to me.
Theirs was a marriage of over 50 years; they had a strong Christian faith, and they had two good grown sons. They had a sense of humor over some of the macabre things we needed to do, and were always gracious to me, who sometimes had to do somewhat aggressive treatment. As time went on, it became more difficult for Irene to stand and to walk. We progressed from a walker to a wheelchair. They often talked of heaven—and how we wouldn’t have to do these treatments there.
We had to admit Irene once for anemia, and transfuse her. At that time, I suggested we contact the Hospice team to discuss care at home. They were not yet ready to sign up for Hospice, but they listened carefully to the description of the program.
About a month later, I made a house-call. This was an unusual event for me, but we had a good relationship, and I realized that even with Lift-Line it would be difficult for Irene to come in to the office—she was almost entirely bedridden. We sat in their sunny living room, and had a good visit. They lived near the new Siena House—a home for unwed pregnant mothers; and they were enthusiastic about the project. Jim had worked before as a counselor at the “farm”—a disciplinary program for boys who had gotten into trouble, and he had lots of good stories of kids who had turned around and turned out ok under his guardianship. He wanted to be the “male mentor” for the men who had gotten these women pregnant—we were trying to come up with a program about fathering, and about establishing a stable relationship with the mother of your child. He said “just call me, doc, and I’ll be there!” Irene had her bed in the living room, and she could look out the window at the neighborhood, and wave at neighbors out for a walk.
At the end of my visit, as I was turning to go, Jim said that he thought he might need to put Irene in a nursing home “just for a few days” to be able to attend to his heart. He had an aneurysm which they had put off operating on, as he felt he couldn’t leave Irene. I told him that would be fine, and asked which day did he wish me to get the transfer arranged. He thought probably Tuesday would be best.
On Tuesday, he took Irene to the SNF in the morning, and went home to take a nap. I received a phone call that evening, as I was finishing paperwork alone in the office. He had laid down for a nap, and had died. A deep keening wail rose out of me, and I just broke down sobbing with devastation. He truly was one of the best men I had known.
I called to see how Irene was doing. She was overwhelmed with grief and disbelief. She needed to be sedated. It only took her a few days to die. Her heart, which had always been strong, wouldn’t quit. They had a double funeral.
I am grateful that we share the belief that they are now together in heaven. Their relationship was one which really gave me hope.
