The Stone Fountain

Antonio was a relatively young man. He was 53, tall, plainly handsome and recently diagnosed with Melanoma. His tumors had spread to his lymph system, brain and abdomen. His abdominal tumors were compressing into his intestines causing a mechanical bowel obstruction. Antonio, Toni for short, was brought onto Hospice service completely unaware of his very time limited prognosis.

Toni was Italian, first generation American. Currently divorced he had two grown children staying with him during his final days. Toni’s mother and father were also present in the home, but continued to tread lightly and we were never allowed to discuss the “D” word.

Toni was bright, alert, stubborn, stoic and a gentle soul. As I look back I believe he was aware of his prognosis. Most people are. They could just never talk about it.

When I first met Toni it was a hot day towards the end of June in 08. Typical hospice protocol with a first visit is a lot of sitting, listening and having the patient and family tell their story. So I sat and listened. His story was filled with how he was going to beat this thing and not give up. He talked about all the things he was going to do to fix up his house, the places he was going to visit and the people he was going to see. He was trying to finish up his life and do the things he had always wanted to do. He was not going to die.

When I asked what he knew of his disease he simply shrugged and said he knew more than he wanted to know. When I asked him what he wanted to know he emphatically said NOTHING. And that is how we left the conversation and the visit. Nothing was discussed to prepare him and his family for the oncoming series of events. Toni had less than two weeks to live.

As the days progressed Toni became more withdrawn. He was lethargic and slept for longer and longer periods of time. His appetite diminished as did his humor. His mother continued to make her famous Orzo e Fagioli soup and swore if he would only eat he would get better. She fed us instead of Toni as he looked on and smiled.

Toni’s list of to do’s became a burden and a reminder of his declining state. Toni’s son was the one who picked up on his father’s frustration in not being able to attend to his list and took up the cause. The back yard needed weeding and the irrigation repaired. Toni had a pile of old stone in the corner of the yard. These were rocks that his grandparents had brought over from Sienna, Italy from the home they had built. Toni always wanted to make a fountain from these rugged Italian stones. There were 53 of them. Toni’s son began in earnest.

As the days continued there was a race with time. We would wheel Toni out to the yard in his wheelchair to watch the progress and help direct the show. Many friends and neighbors had gathered to help. Toni started having hallucinations and delirium. He would see things that weren’t there and his son would have to spend precious time redoing the structure.

One day the son spent hours redoing an area because there was a rat’s nest burrowed under the drainage pipe (Toni’s delirium). Toni became angry with his son and began yelling at him for doing “everything wrong.” Toni’s cancer was spreading fast and affecting many areas of his brain that affected his mood, behavior and speech. He began swearing and using words that required his mother to go to church every morning for purification. She had placed a rosary around Toni’s neck in the hopes that it would quiet the evil spirits. Much time was spent by Hospice nurses explaining and educating the family that all of these outbursts were a normal part of Toni’s disease and not a reflection of his true feelings. However, Toni was angry. He did not want to die. He wanted to be the one fixing the yard.

Toni required daily adjustments to his medications. Each visit was met with a feast of a beautifully prepared lunch from his mother. She found comfort and joy in preparing luscious Italian food for us nurses as we tried to provide meaningful care for her son. It is very difficult for families (especially Italian mothers) to not feed their loved ones during those final days. It is the one thing that they have always done to nourish and show love to their families. We had to show her other ways to express her devotion to Toni.

We taught mom and dad to bathe and shave Toni, a relatively simple act that took hours for them to complete. We had to prepare the water with just the right temperature, using gentle soaps that were not too astringent for his fragile skin or smelled of perfume. Mom focused on the top half of Toni’s body and dad managed the lower half along with the shave. It was a wondrous sight to observe the two of them muddle through the procedure at first very awkward then transform to a beautiful ritual. They were showing love, tenderness and devotion to their son that could no longer talk, no longer eat and no longer swallow.

Toni became more and more delirious as the final days droned on. We provided around the clock nursing care. I made one to two visits a day along with our doctors to try to manage his tortured screaming and pain. Toni was in a hospital bed in his back bedroom. During one of our visits it was suggested by his daughter to bring Toni and the hospital bed into the front living room so he could look out into his yard and observe the construction of his fountain. Once he was moved and put into position he immediately calmed down. His eyes remained fixed on the fountain as the crew was finishing the drain system.

The time had come to turn on the switch to the fountain. It was twilight and the birds were gathering for a drink. The fountain turned on and a golden light was positioned in the front to cast an ethereal Italian summer sunset glow. Mom was serving a special pasta dish to everyone to commemorate the occasion. Toni was in the center of it all as we watched as the water in the foundation poured forth. Toni closed his eyes and died a few hours later, in peace, with no pain and in front of his beloved yard and fountain.

Fifty three stones made up that fountain, a stone representing each year of Toni’s life. This Last Visit story reflects the importance of family, history and unfinished business. The final acts in our final hours may well be the missing key in assuring a peaceful death for ourselves and the ones we leave behind.