The call came on my birthday, one week before Christmas. My mother-in-law, suffering for years from Alzheimer's, had passed away.
Our small overnight bags stuffed with unfamiliar winter clothes, we make the trip from Orange County to Iowa for the funeral and reception. December 27. It would have been my in-law's 50th wedding anniversary.
Cold harsh snow greets us in Des Moines along with family and friends. We see people we haven't seen in thirty years. We keep busy, because to stop is to reflect and to reflect is too painful. It's a study in contrasts: old vs. young, hot vs. cold, sand vs. snow, alive vs. dead.
We prepare to receive extended family, her friends, and our friends. The first two are easy, but the third is surprisingly difficult. It's a reverse wedding reception line. We greet each one at the door, explain which children go with which adults, ask how they knew my mother-in-law, what special things they remember about her, provide mini-synopsis of current life, move on to the next in line.
So I'm thinking about death. Long, slow death from Alzheimer's--devastating, protracted, accepted. It has a name, and it's quite clear it isn't the patient's fault. It wasn't always this way, wasn't always industrialized as it is now.
I'm also thinking about work. Work involves mental illness--specifically depression, anxiety, PTSD--which also has a very definite failure point: death by suicide. Equally devastating, often leaving the living to go on with a lifetime of unanswered questions and self-doubt.
As young marrieds we lived next door to a lovely couple about ten years our senior, both working, with twin boys. Our jobs and life progressed, we moved away. A short time later we got the letter: he had committed suicide, leaving behind those cute little boys and his already stressed out wife. Committed suicide, the language associated with crime.
So how do you know who is sick and why? What is the sickness? Quite often, you don't. As a country we spend far more on the criminal justice system and big-name diseases like cancer than on mental illness or suicide prevention. And yet more people die by their own hand than by the hand of others or by any of those individual well-known diseases.
It's spring. Husband, tween, and I return to Des Moines for the interment and a musical tribute. It's twenty hours of travel during a forty-eight-hour weekend. We're far away, both physically and mentally. As so often happens when sickness arrives, many retreat. I can't honestly say that we were any different or better.
But we're here now, and I explain over and over what it is we are working on. Yes, it's like a blood test or EKG. It's a measure of brain activity. No, it doesn't diagnose. Yes, it does seem curious that the largest drug class is prescribed without a physical measurement. If this is so obvious, why isn't every doctor using it? Why aren't patients demanding it? I don't know. Your mother-in-law would be so proud. This is really important work. It addresses so many unresolved public health problems. Why isn't everyone using it already? I don't know.
But I do know. Scurvy killed far more European sailors than enemy attack. Citrus had been known to cure scurvy as early as 1500 BC, but oranges weren't added to the Royal Navy's standard manifesto until the nineteenth century. Blood typing, cholesterol testing, EKG tracings--these all take measurements crucial to modern diagnosis and treatment. Yet they, too, transited that long, slow arc from introduction to widespread adoption. On average, still seventeen long years.
The call comes on Fourth of July weekend. My father-in-law is sick. It's the big C but the prognosis is good. When we saw him in May, he was in pain. We thought it was emotional pain, but there were physical signs even then. His eyes looked different. He complained of back pain, but maintained his doctor was more concerned about his weight loss.
My husband travels to Des Moines. At first just for a long weekend. Then for a few more days. Then for an entire month. The cancer isn't early stage. It's stage four. It has metastasized. It is so far advanced that they can't identify where it started. Would knowing sooner have changed the path? I don't know.
Once again we all travel to Des Moines. It has become routine. Like when we were young and lived close and would travel there for major holidays and celebrations. We make sure everything is prepared for the evening reception of family and friends. It's déjà vu in the worst way.
The house has been left just as it was the day my father-in-law walked out for what he thought would be a routine test. Everything neat and tidy. Again, we greet the same guests. We hug, we remember, we try not to forget. By this time we are old hands at the cordial introductions, the brief run-down of vitae. And it is brief because instead of updating them on an entire lifetime that has passed, we are only updating on what has happened since May. Just one month since my mother-in-law's memorial service. Just seven months since she passed away.
The church, large and opulent, is filled with people. We must sit at the front. Again, the reverse wedding. Which is the groom's side? I joke. No one laughs. We sit, listen to a recounting of the major themes of my father-in-law's life: family, honesty, faith, high standards, warm regard.
My husband plays his father out with the navy hymn. In doing so, he acknowledges all the discipline and honest dealing of his ancestors. The square deal. The work, the fun, the leadership, the demanding father, the loving husband. And all too soon it's over. We all return to our own lives. We work hard to make things different, better.