Graceful Exit

It began slowly, slyly, initially easy to dismiss. As I look back, I think that Jack, never truly in touch with his body, tried to ignore what he hoped were the peccadillos of old age. He was a rower, a skier, skater, an elite athlete trained to play through pain.

Moreover, in 2005 we had been in a high-impact collision in Sweden, requiring major surgeries on both of us, then 6 weeks of medical care and rest before we could leave our caregivers and friends. When we were able to fly home to family, I returned with a different person. Jack’s awareness, perception, and ability to express himself were not the same. In most ways we both were pitiful, reassembled wrecks, fortunate to be alive, but never to fully recover despite therapy and coaching.

But blessed with an intense gratitude for and love of life we made the most of our time going forward. We accommodated our damaged bodies and luckily kept our minds and memories, memories to which we kept joyfully adding.

Early 2015, through the persuasive recommendation of a client’s daughter, herself a medical professional, we left the care of our soon-to-retire doctor for a Health Partners ‘star.’ He was remarkably perceptive, got a handle on Jack’s lingering Sweden-accident side-effects, started Jack on bi-weekly testosterone shots (to counter lowering energy) and daily SSRI’s. Life was looking up.

However, by June 2018 Jack experienced more and more noticeable fatigue and dizziness, coupled with a great need for naps. Despite many loyal clients’ work and successful lawsuits against the City (for breaking its own laws), Jack decided to retire, albeit slowly. His enthusiasm for being with our grandsons (who live a mile away), traveling, taking courses, reading and working in our Japanese garden, among his many interests, never abated. He was smart, insightful and devoted to helping others. I can’t remember his ever turning down anyone who asked for help.

In March 2021 Jack’s ongoing fatigue was ramping up with “no obvious etiology”, according to our PCP. An April visit and intermittent check-ins by our caring PCP continued as Jack limped along. On May 21 Jack was achy, warm, and dizzy with an elevated WBC, so was prescribed Doxycycline for 2 weeks and tested for Lyme’s disease. That night we went to a birthday dinner with a client; I drove, and Jack muscled his way through the meal, exhausted by dessert.

On June 3 we met with our new PCP, Dr. Kelly Frisch. She ran tick panels and other parasite tests; all were negative. That evening we went to grandson William’s 13th birthday party where Jack became lightheaded and physically unstable. I emailed Dr. Frisch who ordered a brain MRI for the next day (no abnormalities found).

On Saturday morning, June 5, Jack walked over to the kitchen sink as I talked to him from my reading chair. With no warning, he fell straight backward like a plank, his head fortunately missing the refrigerator. But his 220 pounds landed frighteningly loud and although he got up by himself, he wrenched his back. We both knew we were now operating in a different universe, no road map, nothing but surprises.

As I look back, this full body collapse was like the green flag going down on the Indy-500. We were now in a race for life, a race Jack would lose 55 weeks later.

What follows are my email health updates to family and friends. (Should you wish the updates integrated with my medical diary, please email me at lhoeschler@gmail.com.) I offer these personal updates to help others thread their ways through their beloved’s illnesses, treatments and, perhaps, deaths. I know now how different it will be for each person, each caregiver. I think this especially true with cancer, a disease that is an unpredictable as it chews away one life after another. My parents’ slow steady declines over years in no way prepared me for Jack’s aggressive cancer. Every time I thought we had a clear plan, that plan seemed irrelevant the next day.

We did the best we good, I believe, and I have no regrets. As Jack said a couple of months before he died, “Who can say that living to 80 is not a good long life?” He was trying to soothe us both, and our silence signaled no joy, only our acceptance of our joint defeat. We both knew it was useless to rage or hope for another chance.

May you do the best you can, too.

– L.L.H.

Morning of June 17, 2021:

Jack is in Regions Hospital for Testing

Dear family and close friends:

As most of you know, Jack has recently been diagnosed with prostate cancer, with biopsy and bone scan starting this coming Monday to determine whether or not it has spread beyond the prostate. With a PSA of 36 it’s likely…

He has also been experiencing increasing fatigue and dizziness this spring, really ramping up in May. He collapsed in our kitchen almost 2 weeks ago, and this week has had a number of fainting spells. His heart will race up to 200 bpm (our doctor had us get Apple iWatches—good). Unstable, this vital organ.

Last night our doctor had me take him to Regions ER where they immediately began monitoring him and admitted him for continued tests and observation.

Please don’t call me but know I will update you as we get any news.

Love,

Linda

Evening of June 17, 2021:

Update on Jack’s situation

Dear family and close friends:

The good news is that our doctor says Jack will be able to lead his canoe expedition in the Boundary Waters this September—Georgetown crew chums.

The complication is that the route there is, well, complex and full of decisions.

First, the really serious issue: Jack’s arrhythmia and atrial fibrillation (this has caused him ongoing dizziness and physical instability)

1. After meeting with several doctors, including cardiac specialists/surgeons, Jack and I have decided to try the conservative route first and have a pacemaker implanted tomorrow. With that regime Jack will have to take a blood thinner (Eloquis) and beta blocker (Torporol). He will be released from the hospital tomorrow.

2. Jack’s pacemaker will be monitored at Regions’ device clinic. If his arrhythmia does not subside, he will have the option to have two different heart ablations. Evidently, ablation to control the arrhythmia is generally more successful than ablation to stop a-fib.

Prostate Cancer

Yesterday this seemed like the big gorilla in the room, but today it’s a “so-what” (not really but you get the idea).

Jack is scheduled for a prostate biopsy on Monday morning, also outpatient. We then meet with the urologist on Friday to determine next steps. The treatment choices hinge on whether or not the cancer is restricted to the prostate or has spread. Stay tuned.

Thanks for all your good wishes and, again, I request you not call me. We are busy busy with all the docs and nurses here…

Warmly,

Linda

June 21, 2021

Update on Jack’s Situation—Looking Better Today

Dear family and friends:

Just a quick update since many of you have been kind enough to text or email me re Jack’s prostate biopsy this morning.

The short answer: Jack’s procedure was uneventful in terms of discomfort and pain, predictions to the contrary. We meet with the urologist this Friday to get the results and determine next steps (probably a full body scan will be in order), then medication and/or radiation.

The substantive and worrisome issue remains Jack’s heart: his unabated Afib, tachycardia etc. exhausts him and prevents him from getting good sleep. So Jack takes a lot of naps. His heartbeat is often racing and irregular; his EKG often looks like a frenzied battle, not like soldiers marching along predictably and evenly.

Our primary care doctor, Dr. Kelly Frisch, has ramped up the beta-blocker he started on Friday post-surgery. I am now to take his blood pressure several times a day and monitor his heart rate. We need to get the pacemaker helping out a bit more (was it too long dormant in its case?). As of now, Jack has 3 different heart “conditions” diagnosed. Dr Frisch, promises “to figure this out since this is no way to live.” Absolutely!

We consult with Dr Frisch on Thursday, then the pacemaker clinic as well as the urologist on Friday. We remain grateful for the support of our personal and professional friends, as well as family, of course.

Jack’s chauffeur and coach,

Linda

PS If you’d like to be deleted from these updates (which should be less frequent!) please let me know. We well understand TMI and appreciate your not calling us…we are just too busy and tired for now!

27 June 2021

Not Good News…But a Rainbow in Sight

Dear friends:

Friday we had a bit of a body slam at our urologist’s, so we’ve taken a deep breath and are using our time to talk to family. And think. And prioritize.

Basically, Jack’s prostate biopsy (Monday, June 21) shows Stage 5 cancer. Not good. This week he’ll have PET and CAT scans to see where the cancer has spread in his body.

At that point, we leave the urologist’s care and are in the hands of the oncologist. Luckily, we know those hands well: Dr Balkrishna Jahagirdar who has been my doctor for 4 years (breast cancer) and has advised other family members with cancer. His reputation is international and he is a young (early 50’s), intelligent and very kind. Since he is not taking new patients, we wrote him the situation and he wrote back a “do not worry” email, stating that even with this advanced cancer there are hormonal manipulations that show good response, so “please reassure Jack.” We could have cried (I did).

Meanwhile Jack’s heart has taken a backseat position, but not really (it is, after all, the sine qua non in our bodies). Jack remains in Afib, despite his pacemaker, beta blockers and blood thinner. So we expect to confer with our cardiologist this week and discuss next steps.

Dr Kelly Frisch remains our thoughtful internist with whom we met last Thursday. With our entire medical team at HealthPartners we hope to design a reasonable plan that manages Jack’s heart conditions and cancer.

We are both sleeping reasonably well-- a grandson has slept with Jack each night; tonight we’ll try a baby monitor since the boys are off to camp.

Again, thank you for not calling us—we’ll reach out via email for the most part.

With gratitude for your support and love,

Linda

PS Jack is accelerating the handoff of his legal work to Ferd Peters, an attorney Jack has admired for some time. Prescient and prudent.

July 2, 2021

We’re Feeling Surprisingly Calm and Sanguine

Dear family and friends:

I promise you won’t need to read an email update each week…but these past 3-4 weeks have involved tests and doctors’ visits every day. Each test/appointment has generated new information and new possibilities. I’m counting on things slowing down as we get into a treatment rhythm with fewer shocks to our systems.

To recap the issues Jack is facing (updated this week):

Stage 5 (stage IVB) prostate cancer which, we learned this week, means it has metastasized to his bones and lymph nodes. Gleason score of 10. PSA of 36. Jack is knocking it out of the park…unfortunately.
Three heart conditions: Regular to chronic Atrial Fibrillation, Sick Sinus Syndrome and Arrhythmia. The A-fib has been wearing Jack out, and we need to get him in fighting shape to tolerate the hormonal manipulation used to halt the cancer spread.

Jack had a biopsy of his prostate last week (cancer present in all 12 samples), followed by an extensive CAT scan on Monday, and Nuclear bone scan on Wednesday. Dr Jahagirdar, our (kind, thoughtful and renown) oncologist reviewed the CAT scan and left us a message Monday night to meet him in his office Tuesday morning. What a guy! In the office he went through Jack’s CAT scan section by section, noting the impressive number of spots where Jack’s cancer has spread. Dr Jahagirdar then outlined the courses of treatment to halt the cancer, emphasizing that he wants us to be able to continue to travel and to enjoy our family. “Our goal is to control the cancer as long as there is quality of life. The treatment should never be heavier than the disease itself.” When we hit that point, we’ll stop treatment.

Who would think that a meeting with an oncologist could spark such calm, hope and resolve?! Jack walked taller on the way out. Breathe in, breathe out.

Now for the heart of my big guy. Two weeks ago Jack had a pacemaker implant, and started taking a beta blocker and blood thinner. The A-fib still continued and was exhausting him. Today he had an electrical cardioversion to put his heart back into sinus rhythm. The direct-current shock worked and we hope it holds. If not, our dear cardiologist, Marco Guerrero, has outlined 3 or 4 other procedures he can try before doing ablation. (Jack and I happened to see Dr. Guerrero in the hospital cafeteria on Wednesday; he took the time to tell us that he will work his interventions in between the prostate treatments.) Lovely human being.

Jack started PT to help restore his strength and balance (tech said he’s basically strong and since this “take-down” has been so recent, he should recover his strength quickly). At least I’ve gotten Jack to use the Nordic poles that I’ve been preaching about.

So how do we really feel? We feel fortunate, calmer now that we know the magnitude of what we are facing, and best, we have a plan to manage it. No tears, just a commitment to keep working as a team to tolerate our uninvited guest, and to make the best of it. We celebrate our 55th anniversary this summer, 59 years of knowing each other. We’re hoping to mark our 60th wedding anniversary, still enjoying life, still grateful for our wonderful family, friends and professional guidance.

Please pray, burn incense and/or channel good thoughts for us.

With love and gratitude,

Linda

PS. We appreciate your many notes and cards. Thanks for not calling…we need to wait until it slows down around here. Feel free to ask to “unsubscribe” or pass on this email to others.

July 14, 2021

And Here I was Hoping to Write a Bland Update

Dear friends and family:

We very much appreciate your cards and notes, and hope you consider writing Jack directly at jghoeschler@gmail.com. As he says, he’s lucky to have gotten a “two minute warning”, which, while shocking, has the upside of hearing some nice things from the people in our lives. All messages are balm to his soul.

Jack also continues to hand off more cases and clients to Ferd Peterson who has become a regular visitor here, along with Jack’s loyal assistant and near-saint, Marge Virnig.

I function as the coach and critic, pill dispenser filler-upper, record reviewer and keeper (I have a summary timeline of all events and decisions since May 21 when this all began…or appeared to begin). I now truly understand why generals don’t like to fight wars on 2 fronts (which is what we are doing here, with 3 newly-realized heart conditions, and advanced prostate cancer that has metastasized to the bones and lymph nodes). I’m glad I took that juggling class years ago…

Two weeks ago (July 2) Jack had the cardioversion which got his heart back into sinus rhythm where it has stayed, more or less obediently (it still sneaks into afib for short periods, according to his Apple watch, evidently not uncommon). The lower chamber is still learning to act better, so it produces some erratic (and graphically enchanting—but not what you want to see!) beats. The Medtronic pacemaker is “pacing” it and hopefully all the heart chambers will learn to play well together and get with the program. Thank your heart for its loyal service—it’s a beautiful instrument (and a pacemaker is nice but no replacement).

The outcome for Jack has been that since the successful cardioversion, he’s feeling a lot better. That translates into more time working in our Japanese garden where he is the “moss wrangler” par excellence, and 2-mile walks with me each day using our Nordic poles. He’s also got a nice daily strength-building and balance exercise program designed by his physical therapist, and is back to rowing on his Concept2 (2000 meters instead of his usual 3000 meters). And, at the insistence of his loyal but ‘directive’ wife, he uses at least one pole whenever he goes out in our beautiful summer weather. Not bad compared to June’s miasma of symptoms that were taking us all down!

Yesterday Jack had his 2-lead PPM (pacemaker) check-up at Regions and it seems to be doing what it should. But…

Last evening Jack had such a dizzy spell that we were directed to the ER for a 4-hour evaluation. All was all right…but Jack was still dizzy today.

Fortunately, we had an appointment this morning with our dear oncologist, Dr Jahagirdar. Jack’s PSA has dropped from 44.7 to 18.2 so while not in the preferred 0-4 range, headed in the right direction. Other chemistry markers look good.

But because of Jack’s dizziness, low blood pressure and low heart rate, Dr Jahagirdar adjusted Jack’s medications (Jack’s gone on a lot of new “stuff,” all pretty much at once). So we hope for better, although I’m not expecting Jack to take up tightrope walking, literally or figuratively.

Our Japanese garden has become our world, it seems, and its acre+ delights and calms us. We always viewed it as a quieting place, a healing spot—but now we really need its soothing powers. John Powell, our brilliant designer, came here from Texas last week, and spent 4 days building new paths and gardens. Come enjoy the magic with us!

We can hardly believe our good fortune: a loving and helpful family, loyal and caring friends, and a beautiful oasis to heal and help keep up our spirits. Life doesn’t get better.

With gratitude,

Linda

August 13, 2021

Jack’s Health and the Family’s Health

Dear friends and family:

After several two steps forward, one step backwards weeks, and consultation with all our doctors (primary, cardiologist and oncologist), we decided to have surgery at our local and stellar Regions Hospital to correct Jack’s racing heart (the cause of his daily dizziness and instability). Trying additional heart medication at this point seemed imprudent since its side effects involve potential and substantial organ damage—and the prostate cancer is already doing a number on several of Jack’s organs (and bones).

We wanted surgery sooner than later, since Jack has been improving in strength and stamina over the past month (after his successful July 2 cardioversion to stop chronic Afib), even recently outpacing me on our daily 2-mile walks (Nordic walking, but of course!). Jack also recently got back to his daily ERG workouts of 2500-3000 meters and TRX strengthening. With more medication to come for the prostate cancer, with its possible/probable side effects, we wanted to do the surgery soon; Dr. Guerrero, our stellar Electrophys-cardiologist, agreed and scheduled Jack as soon as possible after we made the decision.

The good news here is that yesterday Jack had successful ablation procedures (full anesthesia with admission to Regions Hospital at 6AM and into Recovery at 12:35PM—not the more common 40-minute outpatient procedure) which should prevent his heart racing and concomitant dizziness (Jack’s new Apple watch was a critical to confirming the correlation of dizziness and rapid heartbeat).

Our kind and competent Dr. Marco Guerrero, (who has drawn us many diagrams to educate us about the heart issues and surgical possibilities) gave us a most positive post-surgery summary. First, he was pleased he could easily trigger Jack’s Supraventricular Tachycardia and ablate the offending circuit near the AV node. He then continued to create more scar tissue to stop Jack’s atrial flutter, then added pulmonary vein isolation. These procedures were executed using a camera (inserted through one groin) as well as catheter sensors (inserted through the other groin) that use heat or freezing to scar small areas of heart tissue in order to block the faulty signals causing arrhythmia.

Jack and I spoke about 8AM today, and he reports feeling very good this morning. Dr Guerrero stopped in about 7:30AM and reported no errant heart signals since surgery. Whew! I’m awaiting the hospital’s pick-up call (with Covid I have to wait until 10AM), then returning home with my guy. Yesterday, when I dropped Jack off, he gave me a long hug and kiss, and said “It’s been a good ride, Linda.” Only then did I realize that he was concerned that this might be our final goodbye (He later confirmed his fear.). I had done so much reading in the interim, that I wasn’t too worried about this surgery and would have been pleased to “gown up” and assist!

Over the past month Jack confidently told all three of his doctors that his goal was to be able to canoe the Boundary Waters with his Georgetown rowing chums this September. Rather than send him to a psychiatrist, the somewhat taken-aback docs each replied “probably not”. Our primary physician, Dr. Kelly Frisch, was very diplomatic and said (July 28): “Jack, you’ll have several years you can canoe in the BWCA, but 2021 is not one of them.” She added, to our amazement, that she fully expected that “with the heart ablations and cancer meds you’ll continue to feel better. I am confident you have good years ahead.”

After a dismal summer of too many health challenges and alarms, we could have leapt up and done a happy dance in Dr Frisch’s office (although its small size would have cramped our style!). Those sentences amazed us and gave us visceral hope. We called Kristen (Terry and the boys were out camping) and had a celebratory dinner.

Although we will, of course, continue with regular heart-monitor checks (pacemaker et al) and oncologist monthly visits, there’s a lightness in our step as we look forward to better times. Garden improvements, visits with friends and a few easy trips are in the offing. London theater in the spring? Our fingers are crossed. Moreover, we have a renewed energy to celebrate every day we have together, now and in whatever future lies ahead. Finally, a sincere thank you for all your notes and emails to Jack. These have buoyed his spirits and are important to his healing. As Jack continues to clean his office, cull his files, and hand off his law practice (dull but necessary tasks), your vignettes of good times together, past help he’s given you or our community, have helped beyond measure. One of Jack’s mottos is: “If you never expect to be thanked, you’ll never be disappointed.” But beneath that tough exterior is a wounded body that you are each helping to heal.

Thank you so, so much.

With love and gratitude,

Linda

August 24, 2021

Good News About the Patient…As the Caregiver Limps Along!

Dear friends and family:

Several of you have asked how Jack is really doing. I’ll give it to you, straight!

Although Jack is generally not in touch with his body (at 79 I’m not expecting him to change), I can happily report that he finally looks like himself again (no opinions, please). He often remarks that today he thinks of things he wants to go out and do, rather than always wanting to take a nap. As I watch Jack today, I realize that for years he was lugging his body along…

Today we met with Dr. Marco Guerrero, Jack’s marvelous electrophys cardiologist who, after examining Jack and his recent heart records (Apple watch and Medtronic pacemaker), believes that the August 12 ablation surgery produced the results we had hoped for. Guerrero also thinks that Jack’s fatigue of the past 5 or so years emanated from his SVT, the primary surgical target. Although Jack had one subsequent racing heart episode on August 18th (working in the garden in 90 degree sticky weather), all else is looking fine. If it stays this way for 3 months, the ablation scarring will probably do the trick for life. If not, then we go to AV Node ablation and put the pacemaker in charge. Fingers crossed.

On the prostate cancer front we’ve had another personal miracle: in 5 ½ weeks (July 8-Aug 17) of taking a newly-approved prostate cancer drug, Relugolix, Jack’s PSA has dropped from 44.7 to 5.7, just slightly above normal. Dr Balkrishna Jahagirdar, our oncologist, was so delighted with the lab results that he and his nurse called our home Tuesday evening to tell us. We are able to hold off adding more drugs, because, at least for the time being, Relugolix may suffice.

Before this good-news call and on the same day in clinic, Dr. Jahagirdar remarked how marvelous Jack looked, but how exhausted I looked! The doc’s observation proved prescient, unfortunately, because on Wednesday the 18th, I broke a front tooth biting into a lovely plum and had an emergency repair by our new dentist (What a way to meet Dr Olson, looking like Witch Hazel Snaggletooth!).

On Thursday the 19th, I told Jack that I was running low on energy and suggested that we both had to slow down our social schedule (Jack had become like an awakened Sleeping Beauty who wanted to get up and dance all the time!); Jack agreed. Only a few hours later I went to answer the door and stupidly stood and tried to walk on my “asleep” right foot (I was writing an important hate mail to Comcast with computer on lap, feet crossed.). Well, the right foot buckled, I fell and hit the floor. I ended up reluctantly going to Urgency for a brain CT scan (recommended once over 65) which was negative. But I had two small breaks in my foot where tendons had ripped off pieces of bone. I was put into a clumsy walking cast for 4 to 7 weeks (to sleep in, too).

Urgency advised me to see an Orthopedist soon, so I texted our neighbor, Mark Thomas, an orthopedic surgeon within our health system. He couldn’t see me in his office Friday, but offered to come over to the house on Saturday. Mark looked at the X-rays, declared the boot more of a risk to me, and since the bone pieces were in place, he advised me to wear a sleeve or small brace, and use pain as my activity guide. Mark is now my fairy godfather, particularly valued during this Aestas Horribilis. He has helped me feel so much better emotionally, and physically.

I also take this as a warning from on high to put on my oxygen mask first, and to be more mindful of my own well-being. Please remind me if/when you see me straying.

This Friday, the 27th, we celebrate 55 years of marriage. We decided to abide by our own advice and cancel a trip to Wisconsin. Instead, we are going out to dinner with Kristen and her family. We only wish Fritz and Julia were with us.

Again, thank you for your expressions of concern, love and support. We hope to return the many mitzvahs you’ve bestowed upon us.

With even more gratitude than usual,

Linda

September 19, 2021

Back to Routines…with a lightness in our step…

Dear family and friends:

Jack and I, with some relief, are slipping back into the old and regular routines of daily life: work, play and seeing family and friends. All is done in moderation, and we check one another if we start to speed up and overdo, overdose. After the turbulent summer we have had, predictability, and even boredom, are welcome.

Because Jack’s prostate cancer is advanced, we will continue regular visits with some doctors, particularly our stellar oncologist, Balkrishna Jahagirdar. Jack’s numbers are continuing to improve, with his PSA dropping to 4.2, within normal range (from a shocking 44.7 in June, and after just 10 weeks on a targeted prostate cancer drug, Relugolix). We have been so impressed with this new (approved mid-December 2020) drug, potent and with no discernable side effects, that I invested in its manufacturer, Myovant.

Dr. Jahagirdar told us that this lower PSA meant that all the cancer “hot spots” throughout Jack’s body (prostate, lymph nodes and bones) are regressing and shrinking: good news but this will not always be true. Nothing lasts forever with advanced cancer! Once Jack’s PSA starts rising, and it unfortunately will, the good doctor will add another medication, and so forth, until chemotherapy, the last stage of treatment. Of course, we will always be weighing quality vs quantity of life, and will make the choice of when to stop. Jack hopes to see younger grandson, William O’Brien, graduate high school in 5 ½ years…about what we are hoping for.

In the meantime, Jack continues to lose weight slowly (by choice) and will step up his workouts, lacking the natural testosterone muscle-building boost. Fortunately, he doesn’t have osteoporosis or osteopenia (pleasantly surprising the doctors), probably due to his lifetime of athletics and muscling through workouts and yardwork. Since he doesn’t feel tired throughout the day, as was the case most of the summer, he looks forward to being able to keep in shape. He really looks good these days, surprising many!

Meanwhile, the August 12 ablation surgery on Jack’s heart has wrought miracles, as I wrote you in late August. We meet with Dr Guerrero, his cardiac electrophysiologist, at the end of this month, and 3 months after surgery (November) the ablation-scarred heart will have healed and we expect to declare victory (meaning this surgery will hold Jack for the rest of his life!). So far, Jack’s heart is running smoothly; we are grateful and amazed.

Now for some sentiment. Last Sunday Jack and I drove to Ely, Minnesota to join a handful of his Georgetown rowing chums at the end of their canoe trip in the Boundary Waters, an annual event Jack has organized since 2012 (but for Covid year). We visited our friend, Will Steger, the Arctic and Antarctic explorer at his Ely home and conference center “dream”. We hiked, toured the Bear and Wolf centers, and got to know Ely, an impressively lively town of 3400 folks. But, of course, the best part was hosting old friends here in our adopted state, while Jack looks forward to joining the gang in canoes next summer. In the meantime, Jack will be joining some of his Hoya rowing buddies in Philly this May to celebrate the 60th anniversary of their Dad Vail championship win (capping off an amazing undefeated season—legendary in Georgetown athletic annals).

We are also planning a late November trip to DC to take our elder grandson, Jack O’Brien, a high school junior, to tour Georgetown and see a basketball game. Other family members will join us in DC for a true Thanks-giving for our many breaks and blessings. Jack turns 80 on February 4 so plans are afoot to mark that precious milestone.

I hope (and you may hope!) not to hear from me for a while. We are planning on a long stretch of calm and rebuilding…with no storm in sight. Fingers still crossed for you and for us. And thank you for the many notes and offers to help. We feel your love and appreciate your community of support. You make us feel sanguine and buoyant…what more could we ask for?

With affection and appreciation,

Linda

PS Feel free to pass this missive on to others, as you wish…

October 21, 2021

Palliative…Update on Jack

Dear family and friends:

The term was always there, but I missed it until yesterday. It punched me in the face, so bright, so hard that I tried to ignore it. I closed my eyes, but when I reopened them the word now seemed printed in bold, in italics. Darn it!

PALLIATIVE: from the Latin pallium, palliare, “to cloak.”

I was reviewing the oncologist’s Notes from our Tuesday visit, at which we learned, with disappointment, that Jack’s PSA is rising: from 4.2 to 5.6 in a month. Jack asked if it could be lab error, and the dear Dr Jahagirdar, with a verbal sleight of hand, said “We will re-start the Enzalutamide, adding it to the Orgovyx.” (Jack had stopped the Enzalutamide mid-July due to dizziness—probably a side effect of his heart misbehavior, not due to this drug as it turned out.)

I keep a timeline of Jack’s “events” of this spring, summer and now fall, and wanted to add this medication change and any pertinent physician comments. In reviewing the newly posted online Notes I saw this: “Intent of Therapy: Palliative (explained to the patient)”

I hurriedly searched through the Notes from past visits, thinking this must be an addition, a mistake, a trick. But there it was, and always was, in each of the oncologist’s Notes, that clear and damning introductory line. Palliative. I had missed it in the overflow of symptoms, doctors’ visits, hospitalizations, and surgeries. I knew its truth, but maybe it was just too much for me to admit, to absorb, before.

So that, in a nutshell, dear friends and family, is where we are. The heart is fixed “for life” and Jack looks good, feels well. Folks express astonishment at his healthy appearance, his energy, his commitment to walk and lift weights. He is handing off his law practice, but still helping a few old and new clients. He is again singing with the Swedish Institute’s Male Chorus, participates in three civic discussion groups devoted to improving our local and state governments, studying Italian art online, and attending MindStretch lectures.

We are taking the St Paul family to DC for Thanksgiving (and a prequel Georgetown basketball game and campus tour), traveling with our elder grandson, Jack O’Brien, to Italy over Christmas vacation, then taking our other grandson, William O’Brien, to Portugal and Greece over spring break. As Dr. Jahagirdar remarked, “Yes, do as much travel as you can, now.”

Jack Hoeschler is busy, busy, so much so that I’ve suggested he make a list of the things important for him to accomplish in the next couple of years. Otherwise he, like us all, may fill his time but not write those life stories for our grandsons, or draft the “to do” essays he’s listed. He agrees. We’ll see.

We remain aware that we have that nasty prostate cancer in his bones and lymph nodes. We are attempting to dampen its helter-skelter spray, but can never, ever eradicate. It is a battle that we know we’ll lose, but not when.

Our treatments are palliative, palliare, cloaking, and quite effective so far. But they won’t always prolong this beautiful life, we sorrowfully admit. We are in a losing battle…timeline and skirmishes unknown.

Therefore, at this juncture, I have decided to “wear” a different mindset. Instead of focusing on the Latin roots of palliative, I have my own cloaking, my own sleight of hand. In thinking fancifully and broadly, I said to myself, “Why not pretend the roots of palliative are Greek?”. Therefore, I am embracing the Greek Pallas: goddess of wisdom and warfare.

I will need both Pallas’ attributes going forward.

Thank you all for your love and support.

Linda

January 26, 2022

Shapeshifting in Lake Wobegon

Dear family and friends:

I have been waiting since my last missive of October 21 to offer some definitive news, hopefully positive. But that is not cancer’s way—so put on your crampons and slip and slide with me over the ice and through the crevasses.

Things appeared blessedly predictable back in October, with medications in order and trips planned. Jack looked great, working out and shedding a few pounds. Thanksgiving week we went to DC with our daughter’s family. It almost seemed normal! We scooted in and out of museums that were rustily re-opening. Elder grandson, Jack O’Brien, a high school junior, had a series of great Georgetown (JGH’s alma mater) experiences, thanks to Asst-AD Pat McArdle: Friday basketball game, Saturday in-depth campus tour via golf cart, Sunday soccer Div-1 men’s semis, and Monday scheduled campus visit. Fingers crossed for next year.

But then Covid twisted and turned from Delta and into Omicron (I feel bad that we’re saddling the Greeks with these curse letters/words, lest we offend the chip-laden Chinese!). First, we reluctantly cancelled the Christmas trip to Italy with Jack O’Brien, missing dear friend Larry Siegel’s opera premiere in Tuscany and many Roma reservations. But hey, I’m flexible. I switched out Italy for the Big Apple, purchased tickets to Lehman Trilogy (love Simon Russell Beale) and Rigoletto at the Met for New Year’s Eve, plus renewed my museum memberships. Then a young New York friend’s warning that everyone had Covid (with concomitant closedowns and cancellations), compelled us to cancel again lest we spend our vacation in a hotel—kind of expensive, huh.

So, Jack and the two grandsons invited themselves to Jack’s brother’s home in Hayward, WI for cross country skiing. But an Omicron-sick relative nixed that at the last minute, so the trio re-grouped and went to our Gem Lake cabin (20 acres and 20 minutes from our home), a place within our control(!). They cross country skied, played board and card games and had a lovely time. Jack felt great!

Somewhat like the Ghost of Christmas Past, however, there was also a shadow over all our Christmas holiday activities. In December, Jack’s PSA rose, substantially enough that our oncologist wanted to administer an AR-V7 blood test to determine whether or not Jack had genetic resistance to his androgen-deprivation therapy. If so, this would mean that the convenient pills (Relugolix and Enzaludamide) would be switched out for chemotherapy and trials. Jack would be tethered to the clinic and his timeline compressed.

Then the big guy was literally taken to the ground right after that glorious New Year’s weekend. On January 4, Jack’s blood was drawn for the AR-V7 test (which finally came from and then processed in California). That afternoon Jack slowed to a labored gait, and the next day he could not walk without a walker. He ran a non-Covid-caused-fever (I had my handy-dandy home tests) and could barely function. Our Regions Oncology pros found a Nurse Practitioner who immediately saw him in clinic (with Covid on the rise, we certainly didn’t want to be in a big clinic or ER). After blood and urine tests, she diagnosed severe prostatitis and Cipro for one week, then 3, now 6 weeks.

On January 13th, our marvelous internist, Kelly Frisch, who is able to synthesize all the medical findings while calming our writhing spirits, told us to take heart, that prostatitis causes PSA to spike. We chose to hope, once again, that our current path was good for a while. Jack drank even more water and downed tubs of certified-pro-biotic cottage cheese and yogurt.

At 8AM yesterday we got the hoped-for news that Jack’s AR-V7 test was negative, so pills it would be! We called family and a few friends, then went for Jack’s monthly lab tests. At 5:30PM we learned that Jack’s PSA had more than doubled in 20 days. We figuratively put away the champagne.

Today we met with our oncologist, Dr Jahagirdar, who thinks the PSA spike is, yes, partly caused by the prostatitis, but probably also by the cancer. We need to wait a month, at least, to finish the Cipro course and see where the PSA is. More scans, more tests, different drugs: we’ll see.

In the meantime I appreciate how hard Jack is trying to appear and act normally, minimizing his discomfort and diminishment. We both try to keep the discussion going, not of our deficits, but of the books we’re reading, the topics we’re thinking about, the civic and not for profit activities. Our family and friends. Our love for each other. How lucky we’ve been.

I only wish we could get to the finish line at the same time.

With gratitude to you all,

Linda

February 24, 2022

The More Things Change…

Dear family and friends:

I had been waiting for Jack to ‘land’ on a clear path of treatment (after January’s prostatitis and concerning blood markers) before sending you an update. That landing is not to be, so it seems. We will only “light” on one course of testing and treatment…until that doesn’t work anymore. Hopefully, and with grace, we will “light” on the next palliative care treatment…

We have now learned to plan any activities only 2 days in advance. Although I consider myself very flexible, I was really getting tired of planning, booking, then cancelling, so many trips. On the chopping block went our trip to Spain over spring break with grandson William O’Brien, as well as an East Coast college tour with William’s older sib, Jack. We’re hoping to get to a Georgetown crew reunion March 18-20, but I’m not buying plane tickets until the day before.

As a dear friend who lost his spouse to cancer advised me today, “Acknowledge there is no longer a future to plan. Just enjoy each day, each moment.” Amen.

So back to the big guy. Jack continued Cipro to treat his prostatitis for 4 weeks (not the 6 ordered), ceasing it at the wise counsel of our primary care internist, Dr Kelly Frisch. On February 3, the day before his 80th birthday (and small family party), Jack was grabbing kitchen counters to steady himself; I told him I thought we should visit Dr. Frisch so he could get through his upcoming celebration. Fortunately, Dr Frisch had a cancellation (turned out the magical opening was created by a good friend) so we marched in.

Besides low blood pressure, the doctor was alarmed by Jack’s rising creatinine levels, a signal of poor kidney function. At 1pm the next day, Jack’s birthday, and party day, she called to say that Jack needed an emergency ultrasound of his kidneys. I dropped Jack off at a clinic at 3pm, left to meet the musicians at the club at 4pm, hijacked a friend from Duluth who was coming to visit Jack and asked her to pick him up at clinic and deliver him to the Club instead. Jack arrived just in time for his 5pm party to start! (I felt as if I had just finished a car chase unscathed.)

And what a party it was! The week before Jack’s birthday it was just to be dinner for 6 with Kristen’s family; on Sunday, Jack’s brothers said they and their wives wanted to come to town for the dinner (10); then on Tuesday Feb 1, Philip Brunelle, the Twin Cities brilliant conductor and maestro, asked if he and wife Carolyn could come to the house on Jack’s birthday to play and sing some songs. I suggested they instead come to the Club to do their performance. So, off to the races! On Wednesday/Thursday we invited our priest, Kevin Mc Donough, (we adore him, and besides, priests are handy in dicey situations!) and a few other family members for a lovely set of impromptu performances, a great meal and wine. Highlights included Bradley Greenwald performing a Cole Porter medley (Jack’s fave); grandsons singing original lyrics by Nonna in a tribute to Papa, heartfelt toasts, and Philip’s piano mastery and singalong.

The postlude wasn’t as much fun, although sweet memories can lift and carry you along for quite a while, we have learned.

Jack’s sluggishness, poor color, and kidney disfunction set off a flurry of well-coordinated (by our HealthPartners caregivers) appointments and tests: urology, oncology and internal medicine.

Conclusions: Jack has a very aggressive cancer, genetically driven. Disappointingly, lymph and bone tumors identified last June have grown and metastasized, though not to the lungs and other organs. The swollen, sick right kidney was caused by an expanding lymph tumor compressing the right urethra, blocking urine flow.

Treatment and tests:

Insertion of a nephrostomy tube through Jack’s middle back, directly into the kidney to drain waste into a pouch (performed 2/23 after a procedure to insert a stent up the urethra failed on 2/22 due to tumor compression).
Prostate cores harvested last June are enjoying sunny California where genomic tests (all 23 genes) are being conducted to determine what gene anomalies are revving Jack’s cancer, which treatments might work to slow those malignant growths. In another 2 weeks we should have the genomic analysis in order to better fine tune upcoming treatments.
Nuclear bone scan February 25.
The Big Day, March 1: More blood/urine tests, meeting with oncologist, then first chemotherapy treatment.

Take a breath.

We had hoped to hold off chemotherapy for another 2+ years, but obviously Jack’s genes are driving us along a different path. Once we can name them, we can control them…as the saying goes, and as we hope.

Two things, besides the love of our family and friends, you, are true blessings of the moment in which we live (and in which we must remind ourselves to live):

Jack and I are being more gentle, more kind to each other. We are strong personalities (I hope I’m not shocking you), and ours has been a marriage of banter and pushback (and some poetic times, mostly when I would remind Jack!). Our pace now is slower and we savor each person, each event, each note, each, each...EACH OTHER.
I walk 2-3 miles daily when it’s above 5 degrees (F; this IS the Bold North!). Right now, I’m listening to the Odyssey (Robert Fitzgerald translation; Dan Stevens narrator), having recently completed the Iliad (by the same brilliant duo). I heartily recommend this moving translation and its propulsive reading.

When I feel that my life is out of control, I seat myself by an Attic fire in 8th C BC Greece (or the PC/BCE) and listen to these stirring words, accepting that a pantheon of powerful, yet fickle gods are debating what to do with us next!

And this, for some odd reason, comforts me.

With love and fortitude,

Linda

February 27, 2022

Better News…Medical Error Before

Dear friends and family:

First, thank you for the many touching notes we received in response to last week’s email update. Jack loves hearing your comments and insights (and often remarks that it’s better than hearing them said at his funeral where he might miss a few!).

Perhaps it’s my guilt-laden Catholic upbringing, but I want to correct the record of my last missive when I said that the prostate cancer had increased in both lymph nodes and bones. Inaccurate!

Friday evening, in response to a query I posed to our oncologist (after Jack’s bone scan’s seemingly positive and thus puzzling report), Dr. Jahagirdar called us. The good news: the anti-androgen treatment (pills) Jack’s been taking since last July, has halted the spread of cancerous cells from the prostate to the bones. Dr Jahagirdar was particularly concerned about possible new long-bone tumors and head tumors. None!

Now that we have that baseline, plus the CT scan on Feb 16 that documented the further metastasis of the prostate cancer to the lymph nodes (hence the bulging cancerous lymph node pressing on Jack’s right urethra), upcoming chemotherapy will target the prostate cancer cells running wild in Jack’s lymph system. (Getting the genomic tests will help further fine-tune the treatment.)

Dr Jahagirdar offered this analogy that informed and delighted us:

--Jack has rogue terrorist cancerous prostate cells, like Isis (determined and loosely organized) going wild in his body.

--the rogue cells that invaded Jack’s bones (Germany) have run out of cash (fuel), depleted by the anti-Androgen therapy.

--the terrorist cells that invaded Jack’s lymph nodes (Syria) came with their own cash (fuel) and are still getting outside support and doing damage. These are the cells me must analyze and stop via chemo etc.

As a result of this call, both enlightening and a bit humorous, Jack and I slept well Friday night. We are now ready for battle on Tuesday: more tests and Jack’s first chemotherapy treatment.

Wish us well. At least it’s not more bad news about poor Ukraine.

With lifted and determined spirits,

Linda

PS Jack continues to read, to advise clients and friends, and remains fully engaged in his civic projects (quite a number). Of course, the biggest joy remain our two grandsons—who live but a mile away.

March 17, 2022

Being Mortal…

Dear family and friends:

This missive is not timed according to medical markers, but in response to the increasing number of solicitous calls and notes from you (my wet thumb in the breeze!). Thank you all for your prayers, healing thoughts and concern.

Every day seems to hold a medical adventure and insight, some of which I will share.

Dance analogies keep coming to mind. Perfectly appropriate since Jack and I met at a tea dance at the Willard Hotel in DC almost 60 years ago (September 1962) and we LOVE to dance.

-- Jack and I are doing a square dance with our various doctors. Right now we are do-si-do-ing, allemande-ing right and then left, with our PCP, Oncology and Urology. Cardiology is sitting it out, hopefully patient (and even somnolent) until our regular check-up in June.

--On the other hand, our private lives have swung from a lively-lifelong Galliard to a more stately Pavane. (Turns out, Covid has been excellent preparation for our more deliberate days, hours often snatched from our control by medical needs.)

So what’s up, Doc?!

Good news:

Jack responded well to his first chemo round of Docetaxel (80% dose); the infusion was bracketed by steroid pills which made Jack feel SO good that the steroid dosage is being halved next time. Nuts! But Jack didn’t take a single anti-nausea pill…so far, so good.
Jack gets the next infusion this coming Tuesday, March 22, at a 90% dosage. Other than serious fatigue at the week-and-a-half midway mark, we’re expecting this to go well, too. This will be the 2nd of 6 infusions, the last scheduled mid-June.
After the 2nd chemo infusion but before the 3rd, Jack will have a CT scan to determine whether or not the Docetaxel is shrinking the lymphatic tumors. (Jack’s recent bone scan showed that the Orgovyxx pills had halted further metastases to the bone…but those darn resistant lymph nodes!)
Jack continues to read, talk, listen to/watch podcasts and lectures, go to museums, and engage with his community-minded friends. He’s funny, thoughtful and always ready to help an old client and/or friend. He rows on his machine each morning, lifts light weights, and walks the days he can (our ice/snow is almost melted)

Not so good news:

The genetic test results (analyzing samples from Jack’s prostate tumors harvested last June) were disappointing. Jack carries a pathogenic mutation of TP53, a common appearance in many cancers (30-50%), but with a poor prognosis. Another pathogenic mutation exists on Jack’s AKT1 gene, which, if normal, would be killing cancer cells (apoptosis). Too late to change parents!
Jack’s nephrostomy tube is working well (Nurse Linda keeps a hawk-eye on it) but has halted our trip to the Georgetown crew reunion this weekend (too much equipment involved; too much risk). Fortunately, we will be FaceTimed in for the Saturday evening program marking the successful campaign (led by Jack and a quintet of rowing buddies) to raise $300,000 to help underwrite women’s lightweight crew coaching. Bravo, all!

With an eye to the future:

We had hoped for 5 more years of life after Jack’s diagnosis last summer, scaled it back to 2, and now hope for one year. We are calm, disappointed of course, but make an effort to enjoy each day and try to do something interesting.
We are reading Being Mortal by Atul Gawande. This has helped assure us that we are making good decisions as we progress toward finality, not swinging for the fences, but not throwing in the towel too soon. (Amazingly, the fathers of our oncologist, Balkirshna Jahagirdar, and Gawande’s father were acquaintances in the same small town in India.) Bal is our loving guide, as is our PCP. Dr Kelly Frisch, in fact, all our doctors are tender and helpful.
Dr. Jahagirdar continues to outline our choices going forward, to describe the key decision-making points, including when do we stop all treatment but for pain management. At one visit we sucked in our breath and asked him to tell us how Jack might die, at home. It was okay.

I am so grateful that we have this time to live, to plan, and that Jack has his faculties (well, most of them!) and is not a depressive. We are sobered but calm.

This past weekend Larry Siegel, our dear friend who is also a composer, came to St. Paul to visit us and to take his son, Julian, to see Macalester College. They stayed at our cabin, 15 miles from town. Just before leaving for the airport Tuesday afternoon, Larry played (piano) and Julian sang the waltz lyrics Larry had written for Jack’s 80th birthday (Larry also wrote waltzes for each of our children’s weddings.).

“All through the years, I am here with you. Linda and Jack. Jack and Linda.”

Jack and I waltzed several rounds to this lilting, poignant song in our music room. I teared up, and we held each other tight.

How blessed we were. How blessed we are.

With love,

Linda

12 April 2022

AN OLD CELLULOID FILM…FORCING US INTO FAST FORWARD

Dear family and friends:

I often feel like an onlooker to the celluloid film of our lives, a film that is stiff and brittle in places. The projector sprockets catch the perf holes—but instead of releasing them uniformly, they tear some holes and the film races/blurs through the projector. Then the film catches again…then it breaks again. Our lives are too much lived in fast forward.

Somedays I can barely catch my breath. When I do, I try to inhale deeply, to enjoy what is left of our lives together.

The most cheerful news is that we have a plan. Sometimes it seems like a plan du jour, but hey folks, it keeps us nimble.

In summary:

Positives:

Jack continues to do chemo, generally tolerating it well. His third (of 6 planned) infusion is delayed a week (to next week) so that he can be in better shape. So far his PSA is stabilizing, after initially rising.
Jack stays in good mental shape, reading, writing, and attending discussion groups as he can.
Our son Fritz came to Minnesota for pilot captain training and spent several wonderful days with us—a great physical and emotional help.
Our oncologist has urged us to celebrate Jack’s life while he’s here to hear the plaudits.

--Friends put together a lovely photo book of Jack’s intimate and last-minute birthday party, with a wonderful biography that Jack updated for the project. Enjoy!

--Feel free to write Jack a note if you wish. I can’t guarantee he’ll read his emails—(never a strong suit).

Not so Great:

It is unclear whether or how well the chemo is working. A PSMA radiological scan done last Thursday shows new tumors in the lymph and bone.
Jack sleeps more and is slowing down; he can’t always do his daily exercises. Daily walks with me are now the exception.
Jack has had some terrible days—either caused by UTI’s or, more likely, chemo toxicity. These dark days scare me. For instance, last Saturday morning at 2:45 am we called 911 to check Jack for a stroke; fortunately, Jack flunked so we went back to bed.

However, all day Saturday Jack couldn’t talk in sentences, only dissociated phrases and he was generally immobile. Fritz was here to pick him up and dust him off—although Jack couldn’t remember how he got any place in the house. Our grandsons stopped to visit and went to other rooms and sobbed.

The next day I heard Jack tell a friend he was ready to sign up for hospice care.

Sunday’s partial turn-around gave us a platform to urge Jack to keep on trying; we aren’t ready to let him go.…until he has more bad days in a row. He has agreed.

We have weeks, maybe months left with Jack Hoeschler.

A couple of days ago grandson William O’Brien, 13, sent us a video from late January of Jack and me dancing joyfully to Louis Armstrong. Jack and I watched it this morning as we were about to leave for the doctor. I look pretty much the same (Linda, pull in your stomach!). But the Jack in the video, that vibrant, strong lead, is no longer present.

We’re still dancing in the kitchen, but it’s more the slow dances Jack always eschewed…but we’ve promised each other that we’ll dance once a day until we can’t.

With love and poignancy,

Linda

PS. Being Mortal by Atul Gawande continues to guide our thinking and sharpen our decision making. Gawande’s mantra is not to do everything to prolong life through all modern medicine has to offer, which may lead to a long painful death. After all, when you’re dying, you’re not going to get well! The end of life should remain meaningful and enjoyable—and when it isn’t, go into hospice.

20 April, 2022

IN IRONS…

Dear family and friends:

The analogy that comes to mind for our current situation is being “in irons,” a sailing term we’ve experienced (fortunately, not too often) when there is little to no wind and the boat cannot turn. The sails luff and on a hot day it’s frustrating and miserable. (The term emanates from the use of leg-irons to tether criminals to sailing ship decks, unable to move.)

Jack is doing well amidst small victories and some disappointments. We’re marking time, in many ways, grateful to have time to mark!

Victories:

--On Easter Monday Jack had his nephrostomy removed and an inter-ureteral stent inserted by an interventional radiologist. Losing his ‘bag’, tubes, etc. has worked psychological wonders that have translated to physical uplift—he’s more energetic and productive (in terms of reading, writing and responding to folks)

--Jack also had a bone marrow biopsy on Monday to genetically test the bone tumors to identify effective drugs to slow down that steamroller.

--Tuesday, April 19, Jack had his 3rd round of chemo. He’s feeling well, so far (the steroids help!)

Defeats:

--On Tuesday we learned that Mayo has declared, for the moment, that Jack does not qualify for the just-approved prostate cancer radioactive treatment, LU(tetium)-177. We were so hopeful for this new approach (a ‘game-changer’ and the future approach of many cancer treatments). Apparently Jack’s chemo has had enough effect on his insatiable lymphatic tumors to mute the PSMA (that the LU-177 binds with and nukes, literally). So, for the time being, we will have to stay with the traditional chemo treatments and not bemoan what might have been…

We continue to try to make the most of each day, although some days we’re too tired to do more than basic routines (my walking, his home workout, reading and a few emails). I scan our appearances, personal and home, to measure our care for ourselves, our pride in being, our energy, our fatigue. So far, with the help of friends (who drop off food, write notes, otherwise offer to help) and our two children, (Kristen a mile away, Fritz here for 3 weeks of flight captain training, both godsends), we’re doing quite well.

But we’re also thinking about, lightly preparing for the time when we’ll need more help. When we’ll have to admit strangers to our oasis so that I can stay healthy, and Jack can get the physical support he needs. As one who has seldom missed a chance to delegate (my mother once said I would delegate going to the bathroom if I could!), I am reluctant to surrender any of these waning moments with Jack.

Touching and Motivating: We are trying to help our grandsons with Jack’s exit; both are bereft over the decline of their strong, athletic Papa. On his own, 13 year-old William O’Brien went to a Good Friday service and documented his worry about Jack; Sunday he went to 2 churches for services (both locked and online, to his disappointment). William told me that the best part of Easter dinner at our home was his ‘snuggling with Papa’ during his nap. We are concerned.

So, Papa is going to as many of the boys’ events as he is able. He also invited a dear friend, a man of faith with great experience with young people as well as with personal loss, to meet with our boys and Papa on Saturday. We are hoping they use our friend as a resource going forward, just as he has supported us throughout this unwanted journey. Our collective Via Dolorosa.

Thank you for all the notes you’ve written Jack—whether or not you’re his friend or a friend of our children. We are touched. We are blessed. Keep those cards and letters coming!

Thank you, all.

With gratitude and poignancy,

Linda

April 28, 2022

Hi-jacked!

Dear family and friends:

I had not intended an update for a while since our course seemed smooth and clear just 5 days ago. I even sighed to a few friends that we seemed to be settling into a pleasant routine and that the predictability was good. I now long to be “in irons” again…

What god did I offend in a past life, where every time I think I know where and how we’re going, we end up being hijacked?!

After a lovely week (a number of short visits by close friends) and weekend (Jack O’Brien’s excellent upper-school concert; grandsons and Jack meeting with our dear friend and spiritual counselor; daughter-in-law Julia’s visit and a family dinner at Luci Ancora, our fave), change happened.

Monday stung and brought us to our knees. During the morning Jack was okay, but not great (we attributed his ennui to day 6 after chemo). I was in regular communication with our oncologist’s office, as instructed. Life and Jack seemed challenging but manageable.

By Monday afternoon Jack reminded me of a girlfriend of the 1950’s who had had polio: Jack, like she, had no core strength, unable to move his legs, much less stand. I had to call our 17 year-old grandson, Jack O’Brien, and his father, Terry, to help me wrestle Jack back onto the bed. I called our doc and said we had to go to the ER because even with strong men around me, I couldn’t see making it through the night.

ER on Monday was a zoo, you would have thought it was the full moon. Jack (and even I) were ready to bail, but our oncologist counseled us to stay. Jack eventually got triaged into a room and tests; he had to overnight in a private room in ER which turned out to be a godsend because specialists were on duty who could figure out what was wrong.

At 3AM the malefactor was identified: septicemia.

I won’t detail the week that has followed, but it has been complex and, fortunately, competent. Jack is on 6 infusions a day of antibiotics and will be for at least another two weeks. He will stay in the observation unit of Regions Hospital until he can move to transitional care either in this complex or another place nearby.

He remains stoic and we keep checking ourselves against Gawande’s “treat but don’t overtreat” guidance for a meaningful end of life. (The ER PA said we were the first family he had ever met that cited they were “Being Mortal” adherents!)

Our oncologist believes that once treated, Jack has meaningful months ahead through the summer and beyond…a bit.

We’ll take what we can get. Jack’s a great guy and still full of curiosity and questions.

With determination,

Linda

May 11, 2022

Same song, second verse…a little bit louder, a little bit worse

Dear friends and family:

I had hoped to send a victory note to you: septicemia wrestled to the ground, a new stent exchanged, Jack back on chemo to slowdown the cancer, and, best of all, we’re ready to see occasional guests on our deck as we welcome a slow-to-come but glorious spring. We were ALL ready to “blow this pop-stand”, as Jack would say, that being the hospital and transitional care unit (TCU).

NOT.

Instead, we’re covering ourselves in ashes and wearing hairshirts.

WHY?

After 10 days in Regions hospital, with daily infusions of antibiotics and surgery (stent which was colonizing bacteria was removed and exchanged), Jack was moved to a Transitional Care Unit (TCU) in this complex. The plan was a week of less frequent antibiotics delivered through a PICC line, more intense PT and OT, more freedom and more visitors.

Punctuating Jack’s final days in the hospital, was a glorious legal victory that made big news in the press. The punchline of one major article: “Hoeschler, who is being treated for an illness at the hospital, on Tuesday said the ruling "energized me enough to get out of my sick bed and dance."

So, with a sense of progress being made, Jack moved to TCU a week ago, a lighter, brighter room where he could see family, especially the grandsons, and a few professional friends (handling his cases and projects). Jack’s roommate, Eugene, left after one night, so the room seemed positively palatial! (Jack was concerned that Eugene, of meager means and living alone, was taking his belongings home in plastic bags; he called Kristen to bring some sailing bags for Eugene which thrilled him. I don’t expect to see the nice bags, but then again, I don’t plan to go sailing anytime soon.)

Brother Jake had a long visit with Jack, as did son Fritz and daughter in law Julia. Particularly sweet was a joyful afternoon with the grandsons. Jack O’Brien, 17, sang “Fly Me to the Moon” and William, 13, sang, “You Make Me Feel So Young.” We all foxtrotted around the room to the performers’ sweet baritones, including Papa. Then William cried, put on his sunglasses and went for a walk. Too many good memories recalled, dampened by the knowledge that the party’s almost over…

Yesterday, Tuesday, I had our Edgcumbe windows cleaned, the garden tidied, all readied for a hero’s return to our home of 49 years. But my outwardly cheerful demeanor was dampened by mild dread when I saw Jack’s bloodwork from the day before. Infection suspected, then confirmed by our oncologist, Dr Jahagirdar, with whom we met noon Tuesday.

Things then moved into high gear, like a Keystone Cops segment. While relaxing post-lunch in Jack’s TCU room, waiting for more PT, two aides suddenly rushed in with fistfuls of white plastic bags to jam with Jack’s stuff. I quickly tried to organized Jack’s belongings—but I was out-matched! We were moving Jack back into the hospital, and pronto. I know this sounds slightly stupid, but I began to identify with the evicted trying to slow down the sheriff.

So where does this leave us? Dr. Jahagirdar says this infection, unlike the cancer, is treatable. But, of course, it’s a real drag for all of us.

Jack says he’s ready to die now but appends that he promised our grandsons to make it through the summer…a promise he may have to break but is determined, for now, to keep. Dr. J has also vowed to tell us when it is time for Jack to go into hospice.

Jack’s physical strength now and, indeed, all his life (he continued to work out daily throughout this current year-long battle with heart issues and cancer) bode well for the short term. He also reluctantly accepts that he will continue to be “poked and prodded like a horse in a stall.”

Perhaps most admirable, he is concerned that he not unduly burden those of us who love him. He notes that by staying in the hospital (not really a choice!) I can get more rest at night. He tells me I don’t have to spend all my days with him in the hospital, but I respond that I really enjoy being his advocate (he’s a poor reporter of pain and problems to the medical team!).

Most of all, I just love being with the man I met almost 60 years ago at a tea dance at the

Willard Hotel in DC. We have had a great life together, a “good run” as Jack continues to call it, and we both know we’re in the homestretch.

With emotion,

Linda

14 May 2022

Free at Last—At Least for the Time Being …

Dear family and friends:

I’ve had such dismal news lately (matching our weather of the past 2 weeks) that I thought I’d bother you with a positive update: our big guy is home for now…and, we hope, for the duration.

Jack’s re-hospitalization on Tuesday, May 11, was a stunning deflation, although we tried to remain hopeful, tepidly so. Jack suffered silently, as he does, but I knew he was immensely disappointed. I was worried about his spirits. Could he trudge through another 10 days of antibiotics, and not let this setback become the quiet start of a roaring cascade of increasing diminishment?

Amidst tornado warnings on Wednesday, the Infectious Disease doctor and Hospitalist decided (I won’t bore you with lists of tests and cultures) that the PICC line could be reinfecting Jack and the remaining inflammation (WhiteBloodCount) could be the result of the cancer. We crossed fingers and toes and told no one. In fact, at that point, continued antibiotics and surgery (stent replacement or Nephrostomy tube insertion) were still in the plan. We had already called off visiting relatives, thinking they might not even be able to visit Jack in lockdown.

Wednesday afternoon and evening were spent in conference with various doctors; more tests were ordered and Jack’s PICC line was pulled soon after

Thursday afternoon, when the blood culture FINALLY evinced no bacteria for several days, it was decided to risk sending Jack home, despite his high WBC. We packed up and waited; PT and OT gave Jack his home exercise instructions.

Finally, we got Jack home. He reminded me of our toddler son, Fritz, when he returned home from surgery: I put him in his playpen (allowed in those days!) and Fritz patted its mat and curled up with his toys. Jack, using a cane, slowly walked through our Japanese garden: a nosegay of crabapple flowers, the only bloom on the trees at that point, reached out its branch to greet him. The orioles and hummingbirds returned, fluting orange flashes, and darting ruby nectar kisses. It was like Cinderella being dressed by the birds and butterflies for the ball!

The promise of spring became blessingly animated!

Yesterday, Friday, Jack napped on the deck in his (of course!) deck chair. All seemed right with the world. In the afternoon, some friends, not knowing he was home, stopped off with soup and cake. We invited them to the back deck, and, like the loaves and fishes, food gifts then arrived at the front door: perfectly ripe Harry and David pears, marvelous gourmet cheeses and crackers from Zingerman’s (Ann Arbor). That and Blood Orange Italian soda (Trader Joe’s—we highly recommend) completed our repast. Perfect! (Photo attached)

Then our daughter and younger grandson, William, arrived to snacks (we seem to live on soups, salads and snacks these days) on the deck. Kristen’s dogs looked for sub rosa scraps and our cat, Orion, chased squirrels. Our Eden.

Jack slept well last night and is working out this morning. We have learned to take life a day at a time, because as a wise friend advised us (his wife died of cancer): do not plan for the future, because there is none. After a lifetime of buzzing around the world, we are now ONLY living in the moment. And we savor each moment we have.

With hopeful realism (my mother’s term),

Linda

7 June 2022

The Adventures Continue (or is it The Perils of Pauline!)

Dear family and friends:

I keep waiting to find a clearing in the woods where we can catch our breath, regroup, and see the path ahead…but that seems not to be our fate. Breathlessly we continue…running, lurching, limping, but always holding hands, cheered on and supported by you, our dear family and friends.

It’s hard. Plus, we are now haunted by a paranoid schizophrenic homeless man who thinks he owns the six houses on our lane. He will rap on the front door as early as 3AM and clomp on our decks, sit in our garden shelter and…at least he could pull a weed or two! Not what we need now…

Jack was a champ when he first returned home from the hospital on May 13: enjoying the garden, picking up on his reading and writing, greeting a few friends, attending our grandsons’ lacrosse and baseball games (“All things in moderation,” one of his favorite phrases.). May 17 when all his numbers looked good, he restarted chemo.

The following day, May 18, and courtesy of our guiding-light oncologist, Dr. Balkrishna Jahagirdar, we met with a rock star at the U of MN, Dr. Emmanuel Antonarakis. Dr. A. is developing some exciting new treatments/clinical trials to treat prostate cancer. But blessedly and somewhat surprisingly, he was impressed with Jack’s “robustness” and noted he “appears younger than his 80 years.” Well guys, that is a first in Jack’s history! However, and of course, we’ll take whatever complimentary assessments we can get as we try, try to “watch the doughnut, not the hole.”

We were almost giddy, but then…

During the last week of May Jack seemed exceptionally weak and unstable. We initially attributed this to his being at the low point of his 3-week chemo cycle, only to learn, due to our perceptive PCP, Dr Kelly Frisch, that he had another UTI. So now he’s on amoxicillin for a few weeks, and the antibiotic appears to be slowly, very slowly defeating the infection. We don’t want another hospital stay…for sure.

But just as Jack wrenchingly defeats this latest UTI, the cancer is hungrily at it, chewing away at his insides: CT and bone scans this past week show progressive metastases in his bones and lymph nodes. PSA is rising again, so next week we start a new chemo drug at Regions Hospital and await word from the U about other tacks, when appropriate. Meanwhile, this Thursday Jack will have his ureteral stent exchanged for a shiny new one (sans those UTI bacteria) and a biopsy of a new tumor on his liver. We continue to feel we are cared for and carried by the best of loving professional hands. All have promised to tell us when it’s time for hospice…as we treasure these final days and months with our family.

Speaking of which, Dr Jahagirdar has urged us to celebrate Jack and his life while he can enjoy the words of praise (thank you for the many notes). Therefore, last Sunday, June 5, we had a small home family gathering to hear our 14- and 17-year-old grandsons play Bach’s Double Violin Concerto, a piece Jack hopes they can play (emotionally) at his funeral. Unfortunately, 17-year-old Jack O’Brien was quite sick, so William beautifully played his complex part with his gifted teacher, Ellen Kim, on the lead, accompanied by Tom Bartsch on piano. William also performed a lovely Vivaldi piece.

The program prelude was an announcement that Georgetown University has, to our surprise, just inaugurated the annual John G. Hoeschler Scholar-Athlete Award:

Given to one lightweight and one heavyweight rower who as an upperclassman best exhibits excellence in both academics and athletics during the year. This award honors Jack Hoeschler, ’64, a devoted rowing supporter and advocate, a two-time Dad Vail champion, and the first Duffey scholar athlete at Georgetown from the sport of rowing.

The postlude was tapas and beverages in our library. Love and good conversation abounded, even when Jack bowed out for bed at 8:30.

I’m so proud of Jack, never complaining, trying hard, trying not to try too hard. His robustness and athleticism of past years are serving him well, a wellspring of reserves that he needs, we all need, in this final battle that he is bound to lose, but will lose with all his might and grace.

With gratitude,

Linda

You can go home again…

June 18, 2022

Dear friends:

My beautiful husband, your relative and friend, has returned home to spend his final days in our library.

On Wednesday, June 8, Jack evinced signs of another debilitating UTI: weak trunk and legs. We shuffled him into the car and took him to Regions Hospital ER where he was tested, then admitted, after a couple of hours, long hours. Even the crazies in the waiting room seemed sober and provided little distraction.

Two different series of antibiotic infusions didn’t touch the infection—and an infection didn’t prove out after a bundle of tests. New tumors were seen in the liver, and a biopsy of these showed they were metastases of the prostate cancer—not a new, treatable small cell cancer. Darn, we’re out of options. Cry. Wail. Plan for the next phase…

Tuesday evening, in the hospital, as we saw our treatment options evaporate, I put my head on Jack’s chest, sniffled and then convulsed. Kristen, at my request, filmed Jack who was putting all his physical effort into telling me how much he loved me, how great our life together had been, and what a good partnership was ours. We talked about the Christmas dance at Georgetown in 1963 we fell in love…and pretty much stayed that way…it was lovely. Afterwards, I kept hearing “Save the Last Dance for Me”…

Son Fritz flew in Wednesday morning and helped me bring Jack home from this hospital, Jack’s final time there. After several sessions with PT and OT in the hospital, Jack was reasonably able to navigate the stairs, with one of us supporting his swollen mass with a gate belt tether. Jack was exhausted but cheerful.

Thursday afternoon, when final biopsies were in, Dr. Jahagirdar drove to our home with the news that palliative options were exhausted and he had ordered hospice (we had just called hospice, too.) Our grandsons had just finished playing the Bach Double Violin Concerto for us when the good doctor arrived—it was a lovely late spring day, breezy, verdant, the plants plumped with fresh growth. Picture perfect. Jack sat in his library chair and asked thoughtful questions; the rest of us listened and added a few queries.

That evening Jack sat at the kitchen table discussing Marx and Malthus with our grandsons. He was exhausted but alert, trying hard, then asking for pillows to rest his head on the table. When he decided to go to bed he walked the eight steps to the entry landing then said he couldn’t go further…so we tucked him into our queen bed and Fritz slept with him.

At 3:30AM he got out of bed to go to the toilet, with Fritz’ help, of course, stood up then collapsed—those once-sturdy-strong-athletic legs failed Jack. Totally. Tragically. We managed to get our brave leader back into bed with a complicated maneuver (Fritz’ Air Force training of bringing wounded out of combat served us well), but the future was becoming distressingly clear.

At 9:30AM, Denise from hospice, the admissions nurse, came to our home, met our quartet and laid out the plan going forward. Jack will be bedridden until he dies, at home. Game over. William and Jack O’Brien lay in bed with him, as did daughter Kristen.

At 4:30 PM the promised bouquet of comfort medicines arrived, along with instructions and chart. Cancer medicines out, pain and anxiety control in. Equipment was set up where we had moved furniture out of the library to make room for the bed etc. Jack’s law files were put into plastic bins and into the basement, clearing space for the new gear he we need to make him comfortable and help him exit. Hard to say this.

At about 5:30PM Jack’s “new” room, our library, was practically, and rather gracefully, set up for Jack’s last days in our home. Five men, under the direction of Fritz, got Jack into a wheelchair, pushed him into the library where he contently sat and conversed for an hour, then moved him to the bed. The Western afternoon sun blessed us all…beckoning Jack?

Jack’s siblings are coming to say goodbye: Jake told Jack how much he had meant to him as his athletic pal and defender against bullies. Yesterday brother sweet Jay came with his wife, Judy and daughter Katie. More thoughtful, touching remembrances and gratitude. Today Jack’s sister, Janice, will drive up from La Crosse to greet Jack and bid farewell.

A quiet procession of close friends will stop in to bid Jack adieu from their lives and life in general. Sometimes Jack responds with a sign, other times with some words.

Gabriel Sanchez now sleeps in the library with Jack and wakes up our son when he needs help changing Jack…he is loving and respectful, and Jack likes him a lot. I had lined up a cluster of women to help out, but at this point I need the muscle that men can provide.

Very bittersweet, the essence of Jack remains intact, as his body fails and he sleeps more. This morning he insisted we talk about a few concerns he had for some clients. I reminded him that as of June 14 he was no longer a practicing lawyer and couldn’t help them so forget about it. “That’s not very good business manners” he replied.

About an hour later, Fritz and I bathed and changed him in bed. We tried very hard to be fluid and thoughtful. “How was that Jack?” I asked. “If I have to go through that again, I hope I die by tomorrow.”

I’ll miss my guy, and as we race to the bottom. I suck in my breath, hold onto my hat, and value each moment. Our time left is short…and I love him so very, very much.

Through tears,

Linda

PS Jack worked with our architect, David Wagner, to convert our garage into a library in 2008, replete with a library ladder on a rail. We wanted to take advantage of our largest garden to the West. David wisely designed wider door openings should we need a wheelchair someday. Jack used to joke that he would die in that room and could exit through the garage on a gurney. Funny then. True now.

June 20, 2022

Cole Porter songs are serenading Jack and me in the library...

Dear loving friends and family:

I wish I could call each of you to give you the news, but I don’t have the strength.

Friday, when the flag went down and Jack was officially in hospice, we were off to a sometimes-comedic and absolutely bumbling start. Our initial care was full of well-meaning, clumsy mistakes. But with 2½ hours of training on Sunday by a saint of a home-health-aide, frank discussions among us, and a lot of patience, we were becoming a well-oiled machine. Over the weekend Jack’s siblings and a few close friends visited, our grandsons played violin, and Philip Brunelle stopped in to play Jack’s fave, Cole Porter, on the piano, late Sunday afternoon. We sang and danced in the library, and Jack danced with his hands. By last night we were all calm. We’ve got this, we thought.

This morning Kristen, Fritz and I met with our hospice nurse and social worker. We were hoping for tips and more training, but instead got the news that I must share: Jack, unconscious, has days to live.

We have decided to welcome no more visitors to our home for now, except in our hearts. We accept your prayers and good wishes for a peaceful crossing-over.

Fr. Kevin McDonough is coming this afternoon to bless Jack and us. We plan to formally celebrate Jack’s life on August 22 at St Olaf church in Minneapolis. A few months ago Jack helped plan it with Fr Kevin and Philip Brunelle. Last week, while Jack was having an MRI I wrote the eulogy Jack asked me to give; I later read it to him and he was generally pleased, “a good first draft,” he said (we were always each other’s toughest editors).

Jack has completed most all his life’s tasks. There was more he wanted to do, especially in terms of reading, writing and talking to our grandsons. But his body gave out before mind…and that was his blessing, and ours.

With love,

Linda

June 23, 2022

June 22, 2022 9:25PM

Dear family and friends:

Yesterday was a lovely day for our family and, I believe, for Jack. It ended with his mortal release at 9:25PM. He escaped from us quickly and lightly, thoughtfully, when we had barely turned our backs. He had been worried about causing me, us, stress, of being a burden, so he did his dying efficiently. Pure Jack.

At 3:30AM yesterday I awoke and went to check on him in the library, across the front hall from our bedroom. I sat with him and spoke softly into his ear, not wanting to awaken his kind nighttime watchman, Gabriel Sanchez. But with the 4AM pain medication administration, we caregivers were up for the day.

I changed the music to Bach, simple elegant solos and duets, downloaded from recordings that Jack and I had collected over the years. I told Jack I wasn’t feeling bouncy enough to hear Cole Porter, so I hoped he would enjoy the soothing Bach. I think we both did.

We were alone for a couple of hours, since I had sent Jack’s primary, loving caregiver in this hospice phase, our 51-year-old son, Fritz (Frederick), back to bed for a nap. What an incredible blessing to us all that this kindest of men was available to do the primary physical care of Jack in these final days (due to a training delay in his airline captain FAA check).

I sat closely to Jack in his hospital bed, his eyes unfocused or closed. I started reading poems to him, as we had often done for/to each other. We explored old and new ‘friends’ throughout the day. I started with John Ciardi’s volume, “I Marry You (A Sheaf of Love Poems).” I had given this slight volume to Jack on our first anniversary, August 27, 1967. I read Jack my faded inscription, written as we were about to move to Chicago as Vista volunteers. then followed with the first poem, “Men Marry What They Need. I Marry You.”. After reading Jack a few more poems, I read the final Ciardi poem, “Letter from a Deathbed.” Then on to Yeats, Dickinson and many others. I reminded Jack of some of the places we had read these poems before.

About 9:30AM Jack’s nurse and home health aide arrived to assess Jack, bathe him and change his bedding. We dressed him in a blue and white striped light cotton knit shirt—crisp yet soft. Jack looked ready to captain a sailboat.

Mid-morning our daughter and her sons arrived with mellow joy, with music and stories. Jack O’Brien sang some of his showtunes and opera songs, both boys played violin, and Kristen was on flute. The library was busy but not chaotic. As suggested by our nurse, we each assured Jack that he should feel free to leave us now; he had completed his life’s work, we were all fine to go on without him, we hated seeing him struggle.

About 4PM I was sitting in the room, finishing my draft of Jack’s obituary. When I looked up, I realized Jack’s breathing had changed. Kristen and I called Fritz back from the lake, where we had scooted him out earlier to join our son in law and grandsons for a break. We repositioned Jack, continued with the pain meds, and I resumed reading him poetry. The rest of the team had a lovely dinner in the kitchen, brought by a friend.

At 8:30 I went to bed. I kissed Jack and he mustered the strength to kiss me, to my delight. I repeated that I hated to see him struggling and that he should go as soon as he wished, tonight if possible.

Fritz sat with Jack, then turned to get Jack’s meds ready. Jack was breathing…then he wasn’t. Fritz got me from bed, then Kristen and her family came. Kristen and Fritz washed Jack’s hands and feet and anointed his forehead and extremities with frankincense.

Terry brought in cordial glasses of limoncello with which we each toasted Jack while we sat or stood around him (FN: Because we couldn’t decide where we would meet in the afterlife, not knowing heaven’s architecture, we agreed that we would meet on a marvelous rooftop terrace in Rome where years ago we all drank limoncello on the rocks each steamy June night.)

Consider toasting our patriarch today, and join us, if you can, in Minneapolis at St. Olaf Church at 10AM on Monday, August 22. After the service (Jack helped plan it several months ago), we will walk across the street to the Minneapolis Club for a reception and celebration of a very unusual man, a good man, my man.

With love and relief for Jack,

Linda