The final climb

Many of you already know that Karl reached the summit on Sunday, Feb. 24, 2013 at 10:45 a.m. at University Hospital in Ann Arbor. But I know many of you want to know about Karl's final, turbulent climb. What really happened? This post will be a matter-of-fact one. I'll get into the unbelievable, amazing, beautiful stuff about Karl's last days (and post-death) in a subsequent post. Karl continued to amaze people until the very end. He was so courageous. His obituary can be found at http://www.handlerfuneralhomes.com/fh/obituaries/obituary.cfm?o_id=1988686&fh_id=14562

I'll try, to the best of my ability, to give you these events in chronological order. This is tough, but therapeutic

September 2012 -- After a great summer, that included swimming and taking a few steps, Karl starts to notice his legs aren't moving as well and are becoming more numb. He relies on the little bit of feeling and strength he has in them to transfer from chair to chair and in one case, to stand up and take three steps to and from a pontoon boat.

October 2012 -- Karl thinks perhaps the reason he is beginning to lose strength is because some of the hardware in his back is broken. A CT scan or MRI, not sure which, reveals that the hardware was still good, but no cancer appeared on the scans so Karl decides to buy a toy hauler, convert it into a wheelchair-accessible camper so he can go on the annual hunting trip -- which he had missed the four previous years -- with his buddies.

November/December 2012 -- Karl has lost all feeling and strength in his legs. His oncologist at U-M is concerned and contacts his surgeon at Mayo, Dr. Yaszemski. Dr. Y calls Karl on Christmas Eve and tells him to have a good holiday, but he'd like to get to the bottom of the issues and tells him he wants him to have an MRI, among other images. They will schedule it for after the new year.

Jan. 3, 2013 -- Karl starts off for Ann Arbor to get images. It is in the single digits temperature-wise. The door on his van won't close (it usually closes after going about 500 yards, but this time it doesn't). He comes back home and tries to start the other van. It won't work. By this time, he is freezing cold and comes inside. Mom starts to see the same symptoms Karl had when he had the pneumonia in 2010. She wants to get him as warm as possible as quickly as possible so she gets him in bed and puts a heating pad under his stocking feet because they are icy cold. She checks on his feet periodically and is satisfied that Karl is warming up and he begins to act normal again.

Jan. 5, 2013 -- Because Karl can't feel his feet and Mom's only thought was to get him warm, the heating pad was left on for hours. When Karl takes his socks off, well, let's just say it wasn't good. So Karl and Mom head up to Herrick Hospital. They think maybe it's frostbite because of how cold Karl's feet had gotten. The folks at Herrick decide it's a burn and tell him to go to U-M. We arrive at 10:30 p.m. After checking him out they decide they want to admit him because of the burns.

Jan. 6, 2013 -- At 4:30 a.m. Karl finally arrives at his room in the trauma burn unit.

January 2013 -- Throughout the month they take excellent care of Karl, debriding his burns, etc. In the meantime, he finally gets the MRI he was supposed to have on Jan. 3. It reveals a "mass" lower down near his spine along with one in the area he already had radiated. Dr. Scheutze tells Karl that if the mass in the area already radiated is cancer, there is little that can be done. However, the other mass further down can be zapped. That was a bitter pill to swallow. However, later on Dr. Scheutze talks with Dr. Yaszemski who thinks the mass of greatest concern is probably scar tissue and is likely the cause of the loss of function. Collective sigh of relief. In the meantime, a decubitous ulcer on his bum begins burrowing all the way to the metal in his back, AGAIN. We've dealt with that before. No big deal. We are told Karl will be released so Mom gets a Hoyer lift so he can get in and out of his bed/shower without irritating the decube.

Early February 2013 -- They continue to debride the burns on Karl's heals, which sometimes require them to take Karl to the operating room. At one point, doctors tell us that the wounds are so deep, the bone in his heal is nearly exposed and that if it doesn't get better, they would have to amputate. The way to grow healthy tissue is by eating massive amounts of protein. You can only imagine the copious amounts of meat, protein shakes, etc. Karl consumed. He didn't want to lose his feet. He can't go home because of the wound vacuum they put in each heel.

Feb. 10th (ish), 2013 -- After one of these debriding surgeries, in which they lay Karl face down to do the actual procedure, he begins complaining of severe neck pain. We thought it was a charlie horse. Then the pain spread to his right arm and his finger-tips and thumb start getting numb. Then he loses strength in his right arm. His blood pressure and heart-rate become erratic and he develops a low-grade fever. They transfer him to the trauma-burn ICU. They decide to do an MRI with dye on his neck. It reveals lots of small masses and a larger one, about 2 cm, on his C-spine, C-4 to be exact. They also tell us there are cancer cells everywhere; his brain "lit up." They figure it is metastatic cancer, but until they do a biopsy, they won't know for sure. We are all devastated. They think they can "peel" off the mass, which will not restore function, but it will stop it from getting worse. They tell us if it is metastatic cancer, he can have chemotherapy and radiation. New hope.

Feb. 13, 2013 -- Karl is scheduled for surgery, but they can't fit him in. They reschedule it for Friday, Feb. 15. First case.

Feb. 15, 2013 -- 8 a.m.: Karl is taken from pre-op to surgery. They tell us it will probably be two hours before they begin the operation, which should last about 6 hours, but will let us know how surgery progresses. At 10 a.m. we are told the surgery has begun. At 11:30 we are told they are doing a biopsy. At noon we receive another call saying they were closing. We are, again, devastated. We know what that means. About an hour later, Dr. Orringer, Karl's surgeon, tells us that the preliminary biopsy revealed it was malignant nerve sheath sarcoma and that the tumor they were trying to remove was intertwined with his vertebrae and spinal column. He tells us they removed some of it to give Karl some relief but would endanger his life if he removed any more. He tells us there is no cure. Karl is moved to neuro ICU and is his usual happy self. I tell him the outcome of his surgery and his reply? "Well, that sucks." A nurse approaches me and talks about palliative care. I know what this means, but choose not to mention it to Mom or Karl. None of the doctors approach me about it.

Feb. 18-20, 2013 -- Karl is transferred to the regular neuro floor. I approach his nurse about palliative care. She said there has been talk, but that nothing is definitive. Karl has numerous doctors come in and out of his room. One radiologist tell Karl nothing can be done. Devastation. An hour later, the head of the department tells Karl they can shrink the tumors and perhaps even make them disappear. Hope again. One morning a resident comes in to talk to Karl. He is alone. She tells him to get his affairs in order. He is devastated. I am ANGRY! Later as it turns out, I am complaining to a resident about the situation. I tell her a tactless, moronic resident with no bedside manner, and the compassion of a serial killer came it and told Karl, without a shred of empathy and without any family present for support, to get his affairs in order. After she left, Karl told me it was her! I wonder if she got the message. Then a discharge planner comes in and tells Mom that Karl is ready for discharge to a sub-acute unit. They want him to gain strength so he can handle the radiation. However, she says there are no beds available and asks Mom if she can handle him at home. We are baffled by this.

Feb. 21, 2013 -- I tell the discharge planner I don't think Karl is ready to come home nor is Mom able to take care of him in his present state. At 5 p.m. Dr. Scheutze comes into the room. He tells us they still don't have the final pathology report, but that it is, indeed, metastatic cancer. He said they are unable to do chemo. He thought a seed cell got into the spinal fluid and it "took off." He said he'd never seen anything like it. I ask how many tumors and he replies, "Many." I ask how long. He tells us it depends on whether it's slow-growing or fast-growing. He tells us if it's fast-growing, it may be a month or two. If it's slow-growing, which he thinks it is, it would depend upon how Karl responded to the radiation. Again, devastation. But it typical Karl fashion, he decides he wants to get strong enough to go back out to Mayo to see what Dr. Yaszemski has to say. We agreed.

Feb. 22, 2013 -- I get a call about 6:30 a.m. from my friend Marcy who works at the U. She had just gotten off her shift and was visiting him. As she was about to leave, Karl had severe head pain and then a "staring seizure." Doctors decide to take him to get a CT scan. It revealed there was fluid in his brain. En route to the hospital, doctors called to tell me there was a serious change of condition for Karl. Upon arrival, Dr. Orringer is there to greet us. He tells us (by that time, "us" was Mom, Randy, Marcy, cousin Trese [who also works there], the chaplain and me) that there was little that could be done for Karl. He has hydrocephalus caused by cancer cells clogging the ability for his brain to drain. Normally, they are able to put a shunt that drains into the body, but because Karl has an open wound, they can't do that; he'd get Meningitus which would cause excruciating, uncontrollable pain. The other two options are to make him comfortable and he'd pass within 24 to 48 hours or put a smaller drain in, which would give him 48 to 72 hours. Karl was very lucid and chose to be able to say goodbye.

After countless visitors on Feb. 22 and 23rd, he announced at about midnight on the 24th to my brother Kirk that he was going to die. At 10:45 a.m., surrounded by family and two of his best friends, Karl took his last breath. And we were all laughing when he did. Can you think of a better way for Karl to go to heaven?

My next post, when I get the strength and time, will be about all the amazing things that happened while Karl was in the hospital and after his death. What an amazing dude.

Blessings and love,

Kerry