Friday, August 7, 2009

We can face death well if we live life well

By Robin Palmer, Gifford Medical Center, Randolph, VT:
Living while dying
Metcalf brothers share their father’s loss, their experiences in Gifford’s Garden Room and the life they found within

In life, Steve Metcalf was committed to his work as an educator. In death, he found joys to life outside his office walls, even in his darkest hours.

Perhaps best known in for his 20 years as elementary school principal, Metcalf was a career educator.

He studied history, special education and educational administration, collecting multiple degrees; he served in the U.S. Navy and Naval Reserves, including four years of active duty; and taught for 10 years, primarily in schools in his native New York, all before accepting the principal position that would bring him to Randolph, Vt., in 1985.

He was serious about this work, politics, morality, the meaning of life and fatherhood.

“He worked and he spent time with us,” says his oldest son, Alex, recalling growing up in their Central Street home with a dad who at home checked to see if they were doing their homework and in Vermont strove to make the educational system better for all.

His work in Randolph earned him superintendent roles in first the Orange-Windsor Supervisory Union and then for the last two years at the Montpelier School District where he was embraced as a “visionary,” “leader,” hard worker and a “perfect match” for the school system.

And then the bottom fell out.



Over Thanksgiving and through Christmas last year, Metcalf was feeling an uncomfortable, pressure in his side. He’d had gallstones in the past and thinking these might have returned, he visited his doctor at Gifford Medical Center, Milt Fowler. After trying a medication with no relief, Dr. Fowler ordered a CT scan of Metcalf’s side.

It revealed (and later a biopsy confirmed) the worst possible news: Metcalf had rare and likely incurable stage 4 bile duct cancer.

On Jan. 12 he called his closest allies with the news – his sons, 30-year-old Alex and 27-year-old Ben.

“They found something that they’re worried about” the father told his sons and 24-year-old daughter Emily of Bethel.

“It was just a baseball bat to the head, over and over and over,” says Ben of what it was like to receive the devastating news.

“Your whole perspective on life has just changed and you will never recognize it again,” adds Alex.

The two immediately made plans to come home to Vermont, leaving their homes and careers behind.

Alex was living in Pennsylvania in a house he and Ben bought together and finishing his final semester at Penn State for his Ph.D. in forestry. Ben was in Washington, D.C., working as chief operating officer for the Democrat Governor’s Association, and for other clients through a management, consulting and operations business he started and runs.

The pair returned to attend an oncology visit with their father.

The prognosis was not good. The cancer was in his bile duct, a thin tube that reaches from the liver to the small intestines and transports bile from the liver and gallbladder to the small intestine, where it helps digest fats in foods. But it had also spread outside the liver in lymph nodes and he had spots of cancer on his lungs.

His oncologist called the disease “devastating.” “There is just no stopping this. People just don’t survive this,” Ben and Alex recall being told.

Having survived throat cancer 20 years before in 1989, Metcalf approached his treatment and disease with what his sons knew was often an “irrational” hope for a cure.

“He decided early he was going to give this everything that he had fighting it,” Alex says. “We had to live knowing and accepting this was going to happen and also fighting it the whole way.”

Metcalf underwent first one round of chemotherapy and then a second. The first left him physically feeling fine, but blood work showed it was not effective in treating the cancer. The second round, a different regiment, wreaked havoc on Metcalf’s health, hurting his cancer-filled liver and signaling an end for a chance at a cure.

The news came April 29. A day later, with his health declining, he resigned from his beloved post with the Montpelier School District.

An appointment with another oncologist for a second opinion was scheduled in hopes that a third round of chemotherapy would be possible, but Metcalf never made it to that appointment.

He was hospitalized on May 6.



Amidst it all, the accolades poured in.

He was celebrated at Montpelier High School, where a scholarship was established in his honor, and at Randolph Elementary School, where the library was dedicated to him. The Vermont General Assembly passed a resolution during a special session honoring him as “an exemplary public education leader in Vermont.” And cards, letters and casseroles filled the mailbox and porch steps.

Many of the letters outlined moments or words of wisdom shared by Metcalf with a new teacher or friend that have since directed their careers or lives.

“We always knew how important his work was to him. I don’t think we had a clue how important he was to other people,” says Alex, noting they had to bring in a second refrigerator – and expand their belts – to accommodate all the gifts of food.

And despite the seriousness of his illness, the once all-work Metcalf was having fun.

They took two trips to Florida to sail and play golf, knowing that if Metcalf’s time was as limited as his doctors were saying, he wouldn’t live to see much warm weather in Vermont.

They laughed. They joked, including about the day Metcalf, a bit out-of-it due the medicines he was taking, accidentally shaved off his beard.

On May 2nd they traveled to D.C. to see a Washington Capitals hockey game. Education conferences took Metcalf to D.C. occasionally, so the year before Ben had bought the close-knit trio season tickets. They became ardent fans.

Metcalf, despite feeling very ill, spent the day of May 2 chewing the ears of Sens. Patrick Leahy and Bernie Sanders and Rep. Peter Welch on education issues, and then spent the evening eating out, watching the Capitals game with his sons and hitting the bars until the early morning hours.

“It was ironic,” says Ben, “that Dad taught us that lesson: to stop and enjoy.”



The good times didn’t end in Florida or D.C.

In his hospital room at Gifford Medical Center, Melcalf and his children experienced times of heartache, and jubilation

He entered the hospital with a serious blood infection – a side effect of the cancer, his sons say, and one they thought would almost immediately take his life.

“The doctors didn’t think he had enough in the tank to come out of it,” says Ben. “We started planning the funeral right away.

“And then he bounced back.”

A bout with pneumonia followed. But again Metcalf rallied.

“We sat for almost another month not knowing what the hell was going on. He was on this plateau,” says Ben.

The majority of his time was spent in the hospital’s Garden Room for dying patients and their families, which afforded them the luxury of a family suite, privacy, plenty of room for visitors and around the clock care.

They watched the Capitals and then the Red Sox, say the brothers in matching faded Boston ball caps.

“We laughed so hard all the time. The day he died, we were laughing. For the situation that we were in, we had a lot of fun,” says Alex, noting it was his father who set the tone of his death. “I don’t think I could do it the way he did it.”

They warmed themselves in the sun of Gifford’s Courtyard Garden, just outside the Garden Room. And they benefited from the care of doctors, nurses and cleaning staff that provided “unbelievable care.”

“They were each unbelievable in both physical care and emotional care,” says Ben of Gifford’s nurses in particular.

Metcalf, never one to indulge before, got massages every chance he got.

“Probably one of the best things that he had were the massages,” says Alex, noting his father was in pain and largely bed-bound. “It was one of the few things that provided him comfort.”

The hospital also provided the family “comfort carts” or daily meals.

The massages and meals came free of charge thanks to an annual motorcycle ride the hospital holds to support end-of-life care services at Gifford. This year’s ride, the Last Mile Ride, is Saturday and several riders are riding in memory of the long-time educator.



Steve Metcalf died on June 11 at the age of 62. He was buried on June 21, one day before Father’s Day, in the majestic Vermont Veterans Memorial Cemetery on a hilltop in Randolph Center.

The Metcalfs, who are sharing their story in support of the ride, are appreciative of the Garden Room and “humbled” by riders’ and so many others’ support.

“It was a month of hell, but I can’t imagine having gone through it any other setting,” says Ben of his family’s experience in the Garden Room.

“My aunt left there saying when I’m sick, I want to be here because I’ve never heard of anything like this anywhere,” Alex says. “The fact that this community has this facility is first of all phenomenal and secondly needs to be supported generously.”

The two brothers are supporting the ride and preparing to move on.

They’re cleaning out their father’s home so that it can be sold, mourning their father’s loss and the moments in their lives that he will miss, but they are also looking brightly toward the future.

“There are moments that it is paralyzing that he’s gone,” says Ben.

“I pick up the phone to call him all the time,” adds Alex.

But as the duo works to let go of old habits, and old places, they’re taking their father’s final lesson to heart: they’re seizing life.

Alex will return to Penn State in September to finish his Ph.D. Ben will not go back to D.C. He’s moving to Pennsylvania with his brother, where they plan to go in to business together.

“We’re done waiting for some ambiguous point down the road,” says Ben.

Rather, in their father’s death, they’re living.

Learn more about the Last Mile Ride online at www.giffordmed.org. There is still time to register.

***

Gifford Medical Center in Randolph, Vt., is a community hospital with family health centers in Bethel, Chelsea, Rochester and Sharon and specialty services throughout central Vermont. Gifford is a full-service hospital with a 24-hour emergency department, inpatient and rehabilitation units, a day care, an adult day care and a 30-bed nursing home, the Menig Extended Care Facility, which opened in 1998 on the main campus. The Birthing Center, established in 1977, was the first in Vermont to offer an alternative to the traditional hospital-based deliveries and continues to be a leader in midwifery and family-centered care.

The hospital’s mission is to improve individuals’ and community health by providing and assuring access to affordable and high-quality health care in Gifford’s service area.

Wednesday, August 5, 2009

Vermont Summer Nights

After a beautifully simple dinner with great friends, the night is weighing. Living in the moment is somewhat taxing. It is easiest to forget about the magnitude of your daily decisions. It is easiest to invest solely in the future. It is difficult to live in the joy and the pain of the moment. But there is no better way to live. And so it goes.