John's last days

I haven't written here in a long time, but I want a place where I can share this less publicly than in a Facebook note, and let a few friends know it is available.

Starting in September I was braced, feeling John could die at any time, but he continued to decline slowly.  I read a lot about death over the last year, and it led me to wish very much to be able to talk to him about our years together and have some closure.  He didn’t want to talk about anything that seemed like a recognition of death, but we did have one conversation in December with the help of his friend Debra.  He understood more that I had tried to help him grow with me, and I understood more that it had broken his heart when I healed from childhood trauma because I no longer needed him in the ways I had.

John with his Aunt Florence (age 104) December 2015

John was getting thinner in January and early February, but the main way that he was losing more quality of life was that none of us could understand more than a few words of his speech, even with the amplifier I had bought him.  He had a bed sore that wasn’t getting better, but he wasn’t in pain.  Our daughter Elizabeth visited for a week in early February and then went back up to Boston in time to spend Valentine’s weekend with her boyfriend.

On Feb. 14, I was planning to go to a dinner at the Rensing Center after Peace Church, and I had a cheesecake in the back of my car for that dinner (using up leftover ingredients that Elizabeth had bought).  But when church was over I found a message on my phone from John, just silence, and also a message from his friend Peter Sparks, whom John had called but Peter hadn’t been able to understand him.  I called the nurse’s desk and they said John was ok, no change.  But I was concerned enough to decide to stop and see him anyway.

He told me that evening that he had decided to stop eating and drinking and stop all medication except for sleep (and for pain if needed, but he wasn’t in pain).  His explanation was in the form of several stories about how the care had not been as good at Clemson Downs since they expanded.  There were times when the nurses had been impatient with him or tried to pressure him to have his pills crushed, which he didn’t want.  It was very important to him for me to know all this; I think he needed a reason and wanted some good to come out of his death that way.  He seemed a little scared; I think he thought he would die soon.  I told him that it would be three to five days (that was my incorrect memory of what I had read—it can be 5 days to two weeks).  At that point he wanted it to be over as soon as possible.  I got him some ice chips, which he liked.

I wasn’t sure whether his decision of that evening would hold, but when I went back Monday afternoon after my classes he was taking only ice chips.  He was peaceful, in no pain.  I called his oldest friends, and one, Mary Lou, said she would come from Florida to be with him the next day.  Elizabeth was uncertain about what to do but decided to come Wednesday.  Mary Lou arrived on Tuesday and she and I struggled to understand something he wanted to say Tuesday evening.  We first figured out it was about a party, and then to our surprise realized he was saying he wanted to have a goodbye party that he could be at, that weekend.  His friend Cynthia went forward with organizing a party with the Drinking Liberals and his movie group for Friday, but there were some people who couldn’t come Friday so I organized a second party for Saturday. 

When I was with John he wanted me to tell people his decision and tell him stories of our earlier days.  I did not feel that he gave me a blessing, but he did want my care again.  Pastor Bruce from Peace Church visited several times and John said yes to prayer and anointing.  The hospice chaplain sang for us with his guitar.

Elizabeth arrived on Wednesday, and her first priority was a Skype conversation on my iPad so that her boyfriend AJ could speak to John.  AJ asked John’s blessing to marry his daughter.  John couldn’t say anything understandable by that point, but he smiled.  We used that picture on the invitation to Saturday’s party, which went out to everyone at Peace Church and his wine friends and on Facebook.

People who saw John Thursday commented on how much more peaceful he was than the week before, though he tried to say a few things that we had great trouble understanding. He was able to nod and shake his head and was clear he was not in pain.  I called several of his old friends and held the phone to his ear so they could speak to him.  Nurses had very different ideas whether he would live only a few days or a week or more.

I had gone to the local funeral home to talk to them about alternatives, as John preferred not to be cremated but I was worried that burial in Massachusetts in February would be impractical.  The costs were indeed unreasonable, and so Elizabeth and I had talked with Bruce about whether or not to discuss the issue with John.  We came up with the idea of asking him which wine bottle he would like his ashes to be buried in, but by the time we brought the bottles in on Friday he was so much less aware that we did not ask.

On Friday he was much weaker.  In the afternoon I thought he was napping, but eventually I realized that he had woken up and was hearing but with his eyes almost closed.  I sat with him and held his hand.  Our son Paul arrived and told John that he loved him and thanked John for all he had done to support him, and John smiled at him.  We put John in the reclining wheelchair and took him into the common room for the party Friday evening.  His eyes were mostly closed but we could see a small smile as people told stories about him, which varied from how much they admired him to jokes about John meeting Scalia at the Pearly Gates.  

I had brought clothes thinking I might spend the night in John’s room, but I was so tired after the party and he had so clearly been aware of what was going on that I decided to go home.  He took his sleep medicine, though he struggled to swallow it.  I told the nurse to call me if his breathing changed.

At 4:30 am Saturday morning Feb. 20, I got a call that John had died.  I asked if they had notified hospice and the brain donation people, and I was told they knew I wanted to be there so they called me first to give me a head start.  I woke Paul and Elizabeth, and Paul said he wanted to go.  When we got there John was still completely warm.  I emailed his friend Cynthia, who gets up very early, and she came over.  I called Pastor Bruce but he didn’t get the message for about an hour.  Elizabeth called to say she had decided she did want to come, so Paul went home and she came.  I made up a little ritual saying goodbye to John’s body and then Elizabeth and Cynthia left the room and the hospice nurse and I wrapped John’s body.  He didn’t need cleaning, so I simply swaddled him in a soft sheet over his clothes.   

We then left the room so the hospice nurse could wrap his head in ice.  Pastor Bruce arrived and we sat in the common room waiting for the brain donation transport.  When they arrived they put him in a body bag and Bruce and I and Cynthia walked behind the stretcher following him until he was loaded into the transport vehicle.

Elizabeth and I went out to breakfast because I knew that I needed to not get too low blood sugar, and then we called people and also got out word that the Saturday party was moved to my house.  The main snag was reaching someone at the Cremation Society of South Carolina, but when I finally did, I was content with the conversation. The body had been taken to Charleston for the brain donation, so they just had to make the arrangements to receive it when it was transported back. I had realized after talking with the local funeral home that I didn't need a funeral home to do anything but the cremation, and the Cremation Society was less than half the cost of cremation at a full service funeral home.

At least 30 people came to the party Saturday night, bringing food, and we felt very surrounded by community.  Elizabeth had found pictures of John and put them up all around the living room.  I kept saying that John’s death had been so peaceful and we had had such a good chance to say goodbye that most of all I felt grateful.  I did not get to say goodbye to my father who died in a car accident when I was small or to the stepfather who raised me, who died while traveling, so it meant very much to have had a peaceful goodbye.

The next day Elizabeth and I went to church at Holy Trinity in the morning and felt embraced by community again. We worked particularly that afternoon on an obituary to share, with a much shorter form for the newspaper.  At Peace Church that evening there was a same-sex wedding as part of the regular Sunday service so the congregation could be family to two young men who had been rejected by their families.  Elizabeth was happy to be their photographer.

Monday we started emptying his room at the nursing home and met with the funeral director at the Cremation Society to start the planning.  We had already penciled in Saturday morning for the memorial service so that Paul and AJ could get there more easily.  Tuesday we met with Pastor Bruce and roughed out the service, with Elizabeth clearly wanting many Episcopal words, which felt like familiar, comforting ritual to her.  We decided to sing Swing Low Sweet Chariot because John sang it as a lullaby to the kids and Joyful, Joyful because we sang it at our wedding.  I normally print the bulletin for Peace Church, so we did the final design later in the week and printed it on Thursday.  We also decided to do our own flowers, with the initial idea that we wanted masses of daffodils we could get at Trader Joes.  When I called Trader Joes early in the week they were out, but when we went there on Friday they had them.

The funeral home had not wanted to promise for sure to have the ashes before the service because the paperwork can be slow, and they hadn’t called by Friday morning, but when we went by we were able to pick them up.  Elizabeth and I drove to Charlotte to pick up AJ and then got some takeout dinner to share with some family who came into town by dinner time—my aunt from Washington DC and her son and wife who drove her down.  They supported us while we faced putting the ashes into the wine bottle (which fit less than half).

Saturday Feb. 27 we went to the church early to decorate the altar.  Bruce had suggested glasses with the bottle, and Elizabeth had found a table runner woven by John’s grandmother that fit the altar like it was made for it.  We had bought both daffodils and Japanese iris, another favorite of John’s.  We put the irises in the vase John had given me as an engagement present.

My youngest sister had come in from California late Friday night and stayed at our house and helped us in the morning.  My middle sister and her husband and kids were with my mother in Florida, and our rich Florida relatives had arranged for a Lear jet to fly them from Florida to the Clemson/Oconee County airport.  They arrived at the church about 9:30.

Elizabeth did a reading during the service, but other than that it was Pastor Bruce doing it all; I hadn’t wanted eulogies.  He read the obituary and talked about how he had known John in his last days.  There were about 90 people there—we had realized over the previous week how large our community was and were somewhat expecting that.  

There was a reception at the church and then a lunch at the house for family and closer friends, all with food people had brought.  One of my sisters had suggested that my mother could pay for catering but I said no, you don't understand the south, people will want to bring food.  I didn't even organize that part, a friend from church did. We felt so supported by so many different communities.

My family left around 3 and Paul and Elizabeth and AJ and I took a walk in the botanical garden and I napped a little.  On Sunday I drove Elizabeth and AJ to Charlotte to fly back to Boston.  I was so happy we had done so much of the planning and organizing the funeral ourselves; it felt like a concrete saying goodbye and just the right amount of time focused on that before I started back to work the next Monday. 

End of life wishes

John is mildly cognitively impaired but is losing quality of life physically, though more lowly than I expected when I last wrote about it.  After always saying he didn't want to be kept alive on machines, now that death is closer he doesn't want to give up, he wants more treatment.  In an effort to understand what the choices are, I wrote out what I would want so that I can then ask the question how are his wishes different.  My thoughts are below:

Pam’s Definition of Quality of life:

Major components:

•  The ability to interact socially with others in some way
•  Recognizing family members
• Getting pleasure from some food (able to swallow safely)
• Being able to spend time outdoors or at least looking out a window
• Being able to communicate my wants and needs and be understood
• Being able to enjoy some way of taking in information (reading, internet, music, TV)
• Being reasonably content or happy most of the time
• Not having serious chronic pain

 Less crucial components:

• Being able to live independently
• Being able to read books or magazines or the equivalent
• Being able to regularly contribute something new to conversations
• Having empathy and the ability to help others
• Having insight into my situation

When I have lost two or more of the less crucial components or one of the major ones, I don’t want CPR, surgery (unless extremely trivial), dialysis, chemotherapy or radiation, or medications or devices to prevent long-term disease (such as a pacemaker).  More generally, I do not want any treatment that would cause months of discomfort to extend my life or that would extend my life at the cost of significant cognitive decline or decline in mobility.  Even though I have avoided them in the past, once I am in cognitive decline I do want antidepressants and pain medication if needed, particularly if I am no longer in touch with my spirituality.  I want to be in a group home of some sort so I have social interaction.

When I am starting to lose or have lost two or more of the major components, I don’t want blood transfusions, artificial feeding or hydration or artificial ventilation.  I don’t want hospitalization for any reason except comfort and I don’t want treatment for heart disease, steroids for brain swelling, or antibiotics to treat infection.  Please don’t push me to eat or drink if I stop doing so.  If pain is causing me distress, I want it treated even if that treatment hastens my death.

Update on John

John is more unsteady on his feet.  He can still walk from the house to the car, but with two people to keep him upright.  What scared me most though was that he couldn't eat lettuce, had to pull it out of his mouth.  He said it wasn't a swallowing problem but not being able to move it around his mouth to chew it.  But if his tongue muscles are going, the swallowing muscles are too.

Elizabeth and I and John's wine friend David and Deborah King sat around after his birthday dinner (after he went back to the nursing home) and talked about what he soon wasn't going to be able to do.  I encouraged David to move towards having the wine dinners in the small dining room at the Downs; he said sometimes he has been scared John would fall when he was helping him in and out of the car. Elizabeth found a thermostatic control that will work for John's wine refrigerators, instead of his system of adjusting timers as the temperature of the basement changes.  We also talked about the swallowing problems, which David has seen, and that John's drinking fine wine would be over at the point where he has to have thickened liquids.

I brought the first two points up with John over the next several days.  He said that he didn't think a new control system for the refrigerators was needed this year, though he accepted my saying it would make me feel better.  He said David hadn't said anything to him about being uncomfortable about helping him in and out of the car. I didn't discuss thickening liquids--he would just say he isn't having swallowing problems.

Elizabeth and I talked about what might happen while she is away at school. We agreed that he is getting close to the point of losing quality of life and would not go to the hospital and probably not get further antibiotics if the first ones used don't work (no therapeutic escalation). She wants to come home when something happens, and we will try to have the funeral within a week.

It hurt to feel her pain facing such difficult things.  I also feel so torn between my own instinct to come to terms with and plan for the end and John's denial that he is losing quality of life. I find it hard to feel my feelings when I know he would tell me that they aren't accurate.

letting go of control

I haven't written here about personal struggles in a long time, but I have a feeling that this current one is going to be complicated enough that it will be useful to have a record and perhaps find people who want to talk about these issues.  The challenge I face is letting go of some control, but control makes me feel safe.  This is a challenge where I do want to learn to do it differently.

The immediate situation is that John has started on palliative care/hospice.  From the beginning six years ago his disease has been one that has no cure, nothing but treatment for symptoms.  But we settled into trying to maintain his quality of life.  I researched the disease and made suggestions.  Sometimes he refused, sometimes he resisted but then when he tried it told me I was right.  In the last year his decline has been faster and he has also been much more resistant.  When I asked the doctor about palliative care, I didn't expect that John would qualify for care funded by hospice, but he did.  What hospice means to me is a transition from him living with the disease to dying of the disease, though I say that with the expectation that he has 6 months to a year to live.  But I also realize that their job is to lead us through this process.

Today in church the sermon was about John 1:29-42 and the preacher noted that the first words Jesus says in John's gospel are "What are you looking for?" (John 1:38).  The sermon called for us to listen deeply to the answer to that question inside us and trust the journey.  I felt that fit with my thoughts about letting go of control. But where I got struck is that my first answer to what is my deepest yearning is “safety.” That comes from childhood experiences of abuse and my first father’s death in a car accident, which also makes me feel that God doesn’t protect us. So I had settled into an approach that the closest I can come to safety is trying to see what is coming down the road and figure out how to manage it as best as is possible. That kind of control has worked fairly well for me, so it is very hard to think about letting go of it even partially.

The letting go of control I imagine is letting go (though not completely) of my role as researcher and advocate.  I initially pushed hospice to arrange for John to continue physical therapy, though it turns out that his physical therapist was already thinking it was time to give up.  One motivation for pushing that was that it was important to John, but it was also a way of maintaining my role as the one who fights for what John needs.  I realized I need to some extent to let Hospice be the ones who know what John needs.  But then I have to face my own powerlessness instead of hiding it behind a front.

John is clearly continuing to decline--today he called me to put on his briefs for him, which he has been stubborn about doing himself.  He leans on my arm heavily when we go out, but he does still get out.  He doesn't seem like someone who is dying at this point, but he is increasingly vulnerable as his autonomic nervous system fails.  And he has been clear all along that he would like to die of something else before his quality of life is gone.

Multiple System Atrophy causes of death

Cardiopulmonary arrest	7 (33.3)
Urinary tract infection	5 (23.8)
Aspiration pneumonia	2 (9.5)
Infectious pneumonia	2 (9.5)
Acute aspiration	1 (4.8)
Wasting syndrome	3 (14.3)

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2117630/

"Occurrence of sudden death is a common cause of mortality in MSA and may happen in the early stages while disability remains acceptable." http://tan.sagepub.com/content/3/4/249.full.pdf+html
Citation to: Shimohata, T., Ozawa, T., Nakayama, H., Tomita, M., Shinoda, H. and Nishizawa, M. (2008) Frequency of nocturnal sudden death in patients with multiple system atrophy. J Neurol 255: 1483-1485.
Abstract:

Sudden death has been reported in patients with multiple system atrophy (MSA), although the frequency of this event has not been well delineated. We investigated the frequency and potential causes of sudden death in patients with MSA. During the 5-year observation period, 10 of 45 patients with probable MSA died. The causes of death included sudden death of unknown etiology (seven patients), aspiration pneumonia (one patient), asphyxia after vomiting (one patient), and lung cancer (one patient). The mean survival time of patients with sudden death was 63.0 ± 24.7 months (range, 39–116 months). Among seven patients who experienced sudden death, six were found to have died during sleep. Among these patients, two had been treated with tracheostomy and three with continuous positive airway pressure (CPAP) or noninvasive positive pressure ventilation (NPPV) during sleep, suggesting that these treatments do not always prevent sudden death in patients with MSA. Nocturnal sudden death should be recognized as the most common mechanism of death in patients with MSA.
 

The close relationship between life-threatening breathing disorders and urine storage dysfunction in multiple system atrophy. K Deguchi, K Ikeda, R Goto, M Tsukaguchi, Y Urai… - Journal of Neurology, 2010 - Springer
Abstract:

Survival of multiple system atrophy (MSA) depends on whether a variety of sleep-related breathing problems as well as autonomic failure (AF) occur. Since the brainstem lesions that cause respiratory and autonomic dysfunction overlap with each other, these critical manifestations might get worse in parallel. If so, the detection of AF, which is comparatively easy, might be predictive of a latent life-threatening breathing disorder. In 15 patients with MSA, we performed autonomic function tests composed of postural challenges and administered a questionnaire on bladder condition, as well as polysomnography and laryngoscopy during wakefulness and under anesthesia. Polysomnographic variables such as the apnea-hypopnea index (AHI) and oxygen saturation (SpO₂) and the findings of laryngoscopy were compared with the degree of cardiac and urinary autonomic dysfunction. AHI, mean SpO₂ and the lowest SpO₂ showed significant correlations with urine storage dysfunction. In addition, patients with vocal cord abductor paralysis (VCAP) or central sleep apnea (CSA) contributing to nocturnal sudden death had more severe storage disorders than those without. On the other hand, no significant relationship between polysomnographic variables and orthostatic hypotension was observed except in the case of mean SpO₂. These results indicate that life-threatening breathing disorders have a close relationship with AF, and especially urine storage dysfunction. Therefore, longitudinal assessment of deterioration of the storage function might be useful for predicting the latent progress of VCAP and CSA.

advanced directives

I went to a program this evening on end of life issues put on by our community interfaith organization. The two panelists were a hosptial chaplain and a professor of nursing who specializes in policy. I asked what happens when a person prepares a clear advance directive about medical treatment at the end of life before they develop dementia, but then as the dementia develops they might change their mind. Both speakers answered that if doctors certified that the person was not able to make decisions for themselves then their earlier directive should be followed.

But I don't think it is so simple. When we are adults at the height of independence we think that we would never want to live dependent and not in control of ourselves. But perhaps the spiritual lesson we might learn towards the end of life is that we don't have to be in control of everything to have a worthwhile life, to have value. I do think it better to die of something else first than to die of Alzheimer's, as my grandmother did. But I also don't think a statement in advance that "I would never want to live like that" is necessarily worth more than what the person is actually experiencing even if their awareness of the world around them has become limited.

weekend away

I'm in Massachusetts for the weekend with our daughter, who was very glad to see me. We talked some about death--some of her classmates went to the wake for the girl from her school who died, and it was open casket. That death was such a tragedy it is not surprising that students said the body didn't seem real.

I said that I believed that for older people a good death is possible. Our daughter thought Florence would be a good example, I think because she has had a full life. I said I wasn't sure Florence was going to feel ready. We talked about my father's death, which was sudden, the way he would have wanted it. We didn't mention John, but it still felt valuable to me to talk about death as something that can be natural and peaceful.

One slide

This image comes from the One Slide Project to encourage people to talk about their wishes for end of life. The idea is for people to spread the word and add this slide to Powerpoint presentations they are giving.

We can say yes to 4 and 5, but I don't feel I have enough information on 3. I've worked some on writing out my wishes for myself.

confused day

Yesterday John was having a bad day. He was still asleep when I left early for work, so all I know is that he missed an 11 am appointment. His 96 year old aunt already had a document giving him power of attorney in both legal and medical matters but I wanted that modified to list me as a successor if he can't do it. They had an appointment with the lawyer to sign the new document.

I got home at 2:30 to go up to our son's school for a 4:30 appointment. John wasn't quite ready but the main reason we were late was unexpected traffic, due to accidents in the heavy rain. Driving up John asked confused questions about several topics. Finally I asked him if he knew of a reason why he was having a bad day. He said he didn't know the reason but he certainly was. We did enjoy the play our son was in: "The Complete Works of William Shakespeare, Abridged."

While we were driving, John and I did have a conversation about death, which feels valuable to me as a way of being on this journey together. I had sent him a link about Voluntary Stopping of Eating and Drinking but he hadn't read it. I am interested in the philosophical question--if one believes in leaving death in God's hands then what interventions can one refuse? A feeding tube? Antibiotics? IV fluids? Food and fluids? It seems to me very hard to draw a line. John commented in several cases that he thought that would be a painful way to die. I said research suggests it is not painful for the frail elderly, but I don't think he was convinced. I have the text of a couple of articles on that--email me (pam55sc at gmail) if you want them.

feelings

I've been low this week. I think the conference made the future of caregiving realer to me, plus I feel that expecting John to do some things himself without me urging him isn't going very well. Yesterday a friend told me how when she was 17 and caregiver for her mother with multiple sclerosis, she said "I can't do it any more" and her mother took an overdose of sleeping pills. I was able to talk about that with my peer group of spiritual directors today and I said: "When the synchronicity is that strong what can you do besides remember to breathe?" If I can synthesize the answer I heard, it was that we can trust God to guard some thread of meaning in our lives.

Still on the difficult topic

I realize that I feel so scared of John's intention to end his life before reaching the later stages of dementia because in some primitive place inside me it feels like I am a child who said "I wish you would die" and the person died. That may come from confused feelings from my own childhood; my father died in an automobile accident a month before my third birthday. Both my fathers died suddenly--my (step)father died of a massive stroke while traveling almost exactly three years ago. I wished I could have said goodbye.

further conversation about difficult issues

John and I had another conversation today with the therapist about John's intention to end his life before the dementia gets bad. Today we were also joined by our pastor, who was for several years director of a suicide hot line.

I wanted John to hear my feelings that there is no way he could end his life without it being physically and emotionally messy and terribly hurtful to me and our kids. The thing that did get through to him was that I would feel rejected by him.

He talked about the death of his parents when he was in high school and college. His father died unexpectedly of a heart attack, his mother died a lingering death after a car accident. Both were horrible experiences for him. I don't think he can believe that a peaceful death is possible. He also does not accept the idea that he could have quality of life when he is no longer himself. I spoke of how I have come to understand facing our own deaths as a period of learning to give up control and trust God, but that didn't mean anything to John.

The pastor believes that my views and John's are two positions on a continuum of possibilities and if we keep talking we can come to a shared position. I asked John if he was open to the possibility of changing his view and to my surprise he said yes. I said I was open to changing my view (I do believe in theory in his right to make his own decision). But it is hard to imagine a shared position because there is likely to be so large a gap (I'm guessing three years or more) between when he goes past the point of being able to end his own life and when death can come naturally by withholding treatment. He doesn't want to live in that condition.

further conversation

I told John that he may believe that ending his life (he is clearly talking about some years in the future) would be the right choice for him, but he should not believe he is doing it for his family. I am confident I am well on my way to knowing how to care for him through Lewy Body Dementia, to a natural death, without it being emotionally or financially devastating. He said he wasn't convinced that was possible. I gave him a couple of examples and what seemed to make the most impression on him was my confidence that even if he got violent that could be controlled by medication and after a while he would come out of that stage. Sometimes I feel that reading the Lewy Body caring spouses Yahoo group means I know too much too soon. But here that knowledge was valuable.

I am off to a retreat for the weekend at a place that has been an important spiritual home for me. They have decided not to take guests any more after this weekend. I hope this weekend I will be able to grieve that loss.

difficult conversations

I'm going to repeat what I posted to the Lewy Body caring spouses group because I don't feel very safe writing about this and I got a supportive response there.

At a session we both had with the therapist today, John said that he doesn't want to end up bedridden or not recognizing anyone, he wants to end his life when he is reaching the point of no longer being competent (which we both expect is a number of years away). My own beliefs lead me to discourage that but in the end to respect his decision if that continues to be what he wants; I realize that other people have other beliefs. He doesn't expect me to assist him and I don't think I would be willing to go there. My question for this group is whether people commonly carry that intention out, or whether it is much more common to have that intention and not actually carry it out. I'm guessing that I can't plan on it actually being what happens.

Confused feelings have been churning in my mind, and I was brave and asked for help, called a friend/pastor and arranged to meet her at a coffee shop this evening to talk. She actually turned out not to be the best person to talk to because she knows too much and so I felt pushed. She ran a suicide hotline for three years and has experience of several other sorts. She believes that we can talk about it as a family and come to a decision that we all can accept. But right now where I am at is that my emotional reactions and my intellectual beliefs are so contradictory.