Passing On

Cathy and Linda were the same age, grew up in the same place, and could have been girlhood chums. Instead, they met when Linda was terminally ill and Cathy, a hospice nurse, was assigned to ease her final days.

April 1981By Comments

On November 18, 1980, Linda Mihlan, a 29-year-old mother and housewife in Mesquite, died of cancer of the cervix. She died in her living room, sitting next to her husband, Chuck.

At the moment of Linda’s death, Chuck was talking on the phone to Cathy Little, who is a hospice nurse. Her job is a fairly new one in the world of health care. She looks after people who are dying, who are beyond medical help. Cathy has chosen to spend her life making other people’s deaths slightly more bearable—an ever-larger calling in America, one that sometimes attracts mystics and kooks and one that utterly fails to satisfy a constant demand on modern medicine—that it offer hope of recovery. And yet, for Linda and Chuck Mihlan, it undeniably eased the pain.

Linda’s mother was already dying of lung cancer when Chuck and Linda began dating. In Chuck, Linda’s mother saw a chance of security for her daughter: he had a kind voice, temperate habits, and the prospect of a good job. He was the sort of man, she believed, who would make a good father to the three children from Linda’s first marriage.

Linda’s life had always been a cause for worry. Reared in lower-middle-class poverty in the Garland-Mesquite-Balch Springs area, she had quit school after the ninth grade and married young. She worked as a waitress and bore three boys to her first husband, a hard-drinking, fast-driving man. Now the children were a burden to support. When Chuck came into Linda’s life, Linda’s mother asked them from her deathbed to marry before she passed away.

Chuck did not want to marry until he had known Linda for a full year, but he didn’t want to frustrate a dying woman’s wish, either. In November 1975, five months after he met Linda and only weeks before her mother died, Chuck and Linda were wed at her mother’s home in Mesquite. They moved into a Dallas apartment. Linda stayed home with the kids, and Chuck took himself off every day to his new job as a hydraulics mechanic at an oil field supply plant.

Linda’s health had never been good, and it did not improve after her marriage. Within three years she had her appendix removed, was diagnosed as diabetic, and had a benign tumor removed from her breast. In order to understand these and many other, minor ailments, Linda sometimes paged through a set of medical encyclopedias inherited from her mother, the sort of books sold in grocery stores. But not until the fall of 1979, four years after her mother’s death, could Linda read the chapters on cancer.

For more than a year Linda had been bothered by a vaginal discharge, especially on nights when she and Chuck made love. On two brief pages of The New Illustrated Medical Encyclopedia for Home Use she found such a discharge described as symptomatic of cervical cancer. Once she had diagnosed herself, Linda lost no time. She asked Chuck to accompany her to the doctor’s office, and while she was being examined, he sat in the waiting room, ill-humored at having given up a day’s work to placate his wife’s insatiable obsession with illnesses. Half an hour later, when Chuck was called in, Linda was crying. “Your wife has cancer of the cervix, but she has a good chance of surviving,” the physician told Chuck. But Chuck was distressed. After all, cancer is cancer, isn’t it?

Tumors of the female organs, which thirty years ago accounted for 1 in 5 cancer deaths, account for only 1 in 10 today. In Texas deaths due to uterine cancer have declined from about 750 a year in 1950 to about 580 today, and across the nation, some 78 per cent of women stricken with cancer of the cervix live for five years or more if diagnosis is early. In other words, a diagnosis of cervical cancer no longer means probable death, even in cases like Linda’s where diagnosis comes late. Her doctor was within the statistical bounds of reason when he counseled hope and speed.

The doctor had scheduled further tests for Linda at Pleasant Grove Hospital the following Monday. After the tests Linda asked Chuck to see a lawyer about adopting the children, so that they would be his if she should die. She then called the children together so Chuck could tell them what was wrong. “Linda has cancer,” Chuck said. “Do any of you guys know what that means?”

“Yes,” blurted six-year-old Jimmy, “it means that Mommy is going to die!” Despite assurances that death was neither imminent nor certain, the boys wept. That Christmas Chuck and Linda gave the children everything they asked for. Under the tree the boys found a stereo set, racing cars, and a dozen lesser goodies.

But Linda’s condition did not improve. At Easter she was in the Baylor University Medical Center hospital for a hysterectomy, which was followed by a brief and futile regimen of chemotherapy. By June her weight loss was noticeable, her strength was fading, and she was in pain. Unable to manage her responsibilities, she agreed to place the boys in the Buckner Baptist Children’s Home in Dallas. They did not want to leave her, but Linda was in the hospital as much as she was home now, Chuck had an obligation to work, and there was no one to care for them.

Money was scarcer than it had ever been. Chuck had medical insurance for his family through his employer, but it paid an annual maximum of $10,000 per beneficiary. That amount was exhausted by the time summer began, as were the couple’s savings. Because Linda could no longer drive, Chuck had to miss work in order to accompany her to hospitals and clinics; because there was no money, he had to go into debt to keep her out of pain. Even with the kids at Buckner, Chuck had more work at home than one man could handle.

Sympathetic hospital personnel advised Chuck to call upon the Home Hospice Program. The Dallas Visiting Nurse Association (VNA) hospice, established in 1978, is one of the nation’s largest home care programs for terminally ill patients. At any given time VNA Home Hospice nurses, aides, and social workers are providing advice, treatment, and household help for one hundred terminal patients, most of them cancer victims.

The term “hospice,” which denotes a place of shelter, has for three decades been used in Britain as a name for hospital wards devoted to the care of the terminally ill. The first modern hospice, St. Christopher’s in London, opened in 1948 and set a standard for similar institutions. Hospices, wherever they are, provide staple medical services like oxygen administration and intravenous feeding, but because treatment in terminal cases is largely palliative, they specialize in pain control. Programs built on the British model also offer patients and their families a variety of counseling services, including advice on wills, funerals, and pensions. They deliver services to the patient through teams composed of doctors, nurses, social workers, and volunteers, many of whom are the survivors of former hospice patients. Hospices bring experienced personnel to the assistance of dying patients, but as Chuck Mihlan would learn, they cannot resolve all, or even the most painful, problems associated with death. In hospice theory, and in ordinary practice, the team members function as aides to the patient’s family—upon whom final responsibility rests.

Last July—about the time Linda came into the Home Hospice Program—it and 25 similar projects across the nation were released from the Medicare system’s restrictions on the type and number of visits that would be reimbursed. That federal endowment, though it did not directly affect Linda, did lessen the hospice’s dependence on funds donated by survivors of former patients.

The hospice did not charge Linda and Chuck for hospice visits to their home. The VNA also used privately donated funds to hire household help for them for four hours a day. It dispatched David Overton, a bearded 27-year-old social worker, to assist the couple in facing the traumas of impending death and to help in maintaining contact with the three children in Buckner. The VNA hospice also assigned 26-year-old Cathy Little to visit Linda’s bedside. Cathy had been a hospice nurse for less than a week when she drew the assignment. It proved to be a good test of her preparedness for the new job.

In many ways Cathy fit the profile of nurses whom hospice work attracts. She had not been a traditional nursing school student. Throughout her formal education she had enjoyed literature more than math or science, and in her personal and political views she was trendy and liberal, not staid or traditional. She was convinced that the hospital setting discouraged warmth and closeness. But Cathy pursued nursing anyway, because the work itself appealed to her. Times were changing, women’s liberation was making inroads everywhere, nursing was winning a new dignity—and a new clout—and in that ambience Cathy hoped she could find a place for herself.

For three years after graduation Cathy shifted from job to job, looking for professional contentment. She worked for an oncology, or tumor, hospital; on a cardiac intensive care unit; and on a neurosurgical intensive care unit, all in the Dallas area. She was not favorably impressed. Hospitals were hurried, businesslike institutions, she thought—and working in them was like working in a factory or store. Her patients on the intensive care unit reminded her of greenhouse plants: silent, unmoving, and artificially maintained. Cathy wanted to get away from the chilly atmosphere of organized medicine.

Her superiors in the hospice program hired her because she had technical expertise, because she was experienced with terminal patients, and because she was reasonably well insulated against a common hazard of hospice work, career burnout: her boyfriend of three years, she said in a job interview, would know how to comfort her when the strain of working with dying people gave her doubts about her job. Though it meant a pay cut of $150 a month, Cathy was delighted to be hired by the hospice. No longer would she have to work under a regime of medical spit and polish. Now she would be a member of an irregular, or guerrilla, corps.

For all practical purposes, the American hospice movement dates to 1969 and the publication of On Death and Dying, a manual by Swiss-born psychiatrist Elisabeth Kübler-Ross. For several years Kübler-Ross was an associate professor at the University of Chicago and a staff psychiatrist at its Billings Hospital, where she talked with hundreds of terminal patients. Ultimately she turned her findings into a theory of death psychology. A patient facing death proceeds through five stages, she said: denial, during which he refuses to acknowledge his diagnosis; anger, a phase characterized by blaming survivors for his impending death; depression; bargaining, or the attempt to prolong life by promises, often to deities; and finally, acceptance, the tranquil resignation to fate. In seminars and books, Kübler-Ross advocated training programs to enable lay and medical personnel to act as guides through these stages of the mind. By the time the first American hospice opened in 1974, Kübler-Ross had become a pop saint. She was given keys to the city in half a dozen locales, and she received eighteen honorary degrees in five years.

In actual practice, the five stages Kübler-Ross outlined turned out not to be stages at all, and even their formulator now waffles over the term. Most dying patients do experience denial, anger, depression, bargaining, and acceptance, but not in any sequence. The stages might more accurately be termed moods, because most patients experience them in an unpatterned way. Kübler-Ross’s credibility was further damaged by accounts published in the late seventies of her participation in séances in which widows purportedly achieved sexual union with the spirits of their husbands by coupling with a middle-aged guru named Jay Barham. The Barham scandal would perhaps have finished off Kübler-Ross as an influential figure had the hospices she advocated not been so useful to terminal patients and their families.

Kübler-Ross followed On Death and Dying with more books, and death became a much-published topic: more than four hundred popular works about death were in print in 1980, compared to less than one hundred ten years before. Along with discussion of death came hospices.

Two types of institutions had been developed by the British: freestanding hospices, where all patients are terminally ill, and hospital-based hospices, usually wards of an ordinary hospital reserved for terminal care. But Kübler-Ross noted that most terminal patients she spoke to expressed a desire to die at home, and she called for the creation of home care hospice services. The idea has caught on like wildfire, but probably not as a response to the wishes of the dying. In the U.S. the expense of hospital care—more than $400 a day for cancer patients at Houston’s M.D. Anderson Hospital, for example—is not borne by a program of national health insurance as it is in Great Britain. Some government and private insurance plans deny reimbursement for hospital care not aimed at healing the patient, and physicians are reluctant to authorize hospital admission for patients nearing death. In many cases terminal care may be most cheaply administered outside a hospital setting. The American medical tradition includes visiting nurse associations—the Dallas VNA was established in 1934—that have provided terminal care, if not the whole range of hospice services, for decades. The development of hospice care through VNAs was a logical step for both historical and fiscal reasons.

Logical or not, that development was viewed with suspicion in many quarters of the medical community. Two recent studies by the University of Texas Medical Branch in Galveston show that the hospice concept has won no great favor with Texas physicians. In both studies—one of UT Medical Branch staff, the other of practicing physicians across the state—only two of every five doctors interviewed expressed a desire for additional resources in matters related to death and dying.

One reason physicians have not taken up the hospice cause is that the very notion of terminal illness runs counter to their training and practice. For the best of reasons, physicians are sworn and accustomed to direct their efforts toward saving life. They are reluctant to prognosticate death, because even cases of advanced cancer are sometimes subject to spontaneous remission and there is almost always a method or medication or procedure that has not yet been fully explored. For the physician, the dying patient is not a financial burden—or a beloved relative.

Some of the medical establishment’s distrust arose from more mundane concerns, however. In the absence of both clear standards defining hospice care and any licensing or legislative requirements, the field was ripe for experimentation and abuse. Nursing homes have in some cases merely restyled themselves as hospices without expanding their services. Nobody knows how many projects calling themselves hospices exist in the U.S., and even the fledgling National Hospice Organization (NHO) is unable to give an account of its membership. Many of the organizations affiliated with the NHO have not established hospice operations yet, and some existing programs may not measure up to the NHO’s standards.

For their part, most hospice advocates are quick to point out that hospital and physician care is characterized by the commitment of expertise only. Medicine, in pursuit of technological miracles, has lost its human face, they say. Hospice programs aim to restore warmth, as well as familial and financial considerations, to the bedside manner of medical workers, and that’s why hospice programs, generally speaking, are hotbeds of scorn for the medical establishment. Nurses like Cathy Little see themselves as leading a movement for the reform of not only terminal treatment but the whole medical profession. The typical hospice worker is part scientific provider—nurse or doctor or social worker—part chaplain, psychologist, or consoler, and part agitator or visionary.

Cathy Little took two six-packs of Ensure from the room where donated supplies were stored and carried them downstairs to her maroon Pontiac Phoenix. She put the squatty orange-and-white cans onto the back seat, between her briefcase and the catheters in plastic packages, above the bags of Chux pads on the floor. Then she drove northeast, toward the suburban territory she works for the Home Hospice Program. Cathy was taking the Ensure, a milkshake dietary supplement, to Linda Mihlan.

Ensure would improve Linda’s life in two ways. She didn’t like the taste of her methadone, a bitter narcotic, even though it came with a grape syrup additive, and Ensure would give the drug a more palatable chocolate flavor. It would also give her concentrated nutrients. Nothing could keep Linda, who was already using a walker, from growing even thinner and weaker, but Ensure might slow down the process.

As Cathy drove, she mapped out the day ahead of her. She would give the Ensure to Linda that afternoon. Other patients in Garland would come first, and then patients in Mesquite and Balch Springs. Six weeks earlier, when all twenty of Cathy’s patients had been alive, Cathy sometimes had not returned home until nightfall. But even then she had planned her visits to Linda for late in the afternoon, in order to spend as much time there as Linda wanted. Linda was a special patient because she put Cathy to the test, not only as a nurse in a blue-and-white uniform but as a creature of empathy. Dying of cancer is not always painful, but Cathy knew that Linda Mihlan, with or without Ensure, was likely to suffer great misery. Cancer sometimes does not yield to even the best or most innovative interventions of the medical profession.

Cathy’s task as Linda’s nurse was essentially to supervise a regimen of pain control. After a month-long summer hospitalization Linda had been prescribed Dilaudid capsules and injections of Demerol, a painkiller, with Thorazine, a calmative. Pain control is controversial among doctors and patients alike, and the results in Linda’s case show why. Most physicians prescribe barbiturates with a sparing hand, lest patients develop dependencies, and many patients, believing that agony is preferable to addiction, hold themselves back from the medicine bottle. Linda had reached a point where relief came only when she was stuporous from high doses of her painkillers. When her injections were delayed she suffered both the psychic and the physical pain of withdrawal. In October, at Cathy’s request, Linda’s doctor began prescribing methadone for her.

Methadone is synthetic morphine, as potent as any painkiller available. Its euphoric effects have made it an alternative to heroin in medical therapy as well as on the black market. In the beginning it stupefies its users, and it is a powerful addictive agent even though, like any pain remedy, it is not effective for all patients or at all times. Linda’s body usually responded well to the drug, and it enabled her to resume some of those activities that pain had taken away. She entertained her children on weekends and, supported by a walker, helped in the kitchen on weeknights. Sometimes, in the wheelchair that substituted for muscle strength, she went with Chuck to modest restaurants or to flea market sales.

But even methadone is not infallible. It did not end Linda Mihlan’s—or Cathy’s—suffering. The crisis for Cathy came one afternoon in October when she made a scheduled visit to Linda’s home. Cathy’s ring at the door was answered by the household aide, who, before Cathy crossed the threshold, warned that Linda’s pain was out of control.

When Cathy walked in, Linda, at 29 just three years older than Cathy, was lying in a pink nylon gown atop an artificial sheepskin on the old green couch in her living room. On a coffee table at her side lay her usual appurtenances: a photo album, a Bible, and a bottle of diet Dr Pepper. The patient, now weighing less than one hundred pounds, barely noticed when Cathy approached and inquired about her condition in a quiet, tentative voice.

Linda didn’t hear because she was moaning. “What is happening to me? Why do I hurt? Somebody please help me, tell me why I hurt.”

“Linda, Linda,” Cathy said, kneeling beside the couch, “why do you think you are in pain?”

But Linda continued her pleading. “Can’t you give me a shot? Call the doctor! Do anything!”

There was no question, by that time, of giving Linda any injections. That route had already been tried and had lost its effectiveness. All that remained was to administer methadone. Cathy rose, measured the dose, mixed it with Ensure, as she had for weeks, and spooned it into Linda’s mouth. Then, kneeling, she checked her patient’s blood pressure and pulse, busying herself and comforting Linda while she waited for the drug to take effect.

But the drug did not take effect. Half an hour later, Linda’s emaciated frame was still curled with pain, her mouth still strained. She begged for a mercy that, she knew, would not be forthcoming.

“Linda, there’s nothing more I can do except just hold you,” Cathy told her patient, trembling herself. She encircled Linda with her arms and in a quiet voice told her to breathe slowly, ever so slowly. Linda complied, and as her respiration rate slowed she nodded faintly and hummed or snored. In a few minutes she fell into an uneasy sleep. Cathy carefully slipped out of the house, late for her team conference meeting at the hospice.

As the other nurses, social workers, volunteers, and household aides compared notes and discussed treatments for patients, Cathy kept silent, offering no advice and asking none. When her turn came to report, conference leader Charles Kemp asked about Linda’s condition. Cathy blurted out something about intractable pain, then broke into sobs.

Kemp, who sat on Cathy’s left, put his arms around her, as did the nurse on her right. Rather than admonishing her to stop crying, both encouraged her to express herself. Phrase by phrase, Cathy explained her difficulties with Linda’s pain control program. She also talked about how Linda’s impending death frightened her. After all, Linda Mihlan was in many ways her double: they were the same age, they had both been born and raised in the Dallas area and spoke with the same accent, and, as her hospice co-workers had noted, they were both women of a somewhat serious disposition, friendly but sometimes somber. Before the discussion of Linda’s status was over, half a dozen people were crying with Cathy. It was the sort of mutual support meeting that hospice workers claim they must have in order to face their jobs. They must give strength to families facing death, and in the course of their work they themselves often need emotional bolstering.

The Texas hospice movement’s leading visionary was nurse Charles Kemp, 36, a tall, thin, bass-voiced, black-bearded man. Kemp was a Marine machine gunner during the Viet Nam War, and he returned home disillusioned and frightened. He became a counter-culturist, and even today he neither blinks nor grins when he cites Dr. Timothy Leary as an authority on matters of metaphysics. Like Kübler-Ross and other hospice pioneers, Kemp has unorthodox ideas about the afterlife, and though these views do not enter into his hospice or nursing work, they were in part responsible for his interest in the crises of dying patients. Kemp graduated from nursing school in 1975, with some help from the GI Bill, and three years later completed a master’s degree at the University of Texas at Austin. He went home to Dallas, where he and a handful of associates began providing ad hoc hospice care to terminal patients, sometimes on a voluntary basis.

His efforts won approval in the nursing community, and in the fall of 1978, at the request of the VNA, he put together a hospice program. Though the project grew—it now has a paid staff of fifty and a $1.5 million annual budget—late last year Charles Kemp resigned as director and was replaced by a licensed nursing home administrator whose background was entirely orthodox and bureaucratic. Kemp had become a victim of career burnout. His new occupation, however temporary, is as a yardman and gardener. “I just got sick and tired of death,” he says. But Charles Kemp was there when Cathy wept at the hospice meeting, and he, more than anyone, gave her the resolve to go on. Though he ultimately gave up himself, Kemp brought dozens of new hospice workers into the program and steeled them.

Linda’s condition improved in early November, and once again she was able to venture out in her wheelchair. One of the few wishes she expressed was to visit a simple seafood restaurant on Buckner Boulevard; methadone allowed her its fulfillment. Though she was weak and by then weighed not more than ninety pounds, she and Chuck also went one Friday night to dinner at a Bonanza steakhouse in Mesquite, at the invitation of a co-worker of her husband’s. That dinner was her last meal.

Over the weekend Linda weakened rapidly. She refused food and on Monday laid her cigarettes aside. She could no longer rise from bed and slip into her wheelchair; Chuck now carried her from room to room. Her complexion grew pale, her body turned cold, and her breathing became labored. On Monday, when Cathy Little visited the home, Linda’s blood pressure was abnormally low. On Tuesday both Cathy and Chuck knew that she would not live long.

Chuck called Cathy outside the front door of his house. “I don’t know, Cathy,” he said, “but Linda is getting weak pretty fast. I don’t see how she can make it another week.”

“I think you’re right,” Cathy told him, reaching for his hand.

Chuck braced himself, as he had for months, in the belief that harsh news hurts less on a stiff backbone.

Some premonition told Cathy to give Chuck her home telephone number. She wrote it out on a slip of paper and, as she left, told Chuck to call her if he had any problems that night.

Linda lay on the old couch in the living room that evening, sometimes whimpering, sometimes wailing with pain that not even methadone could hold down. She hurt, as she had for days, in her right thigh, and she hurt in her bowels as well, for that evening diarrhea had come upon her. About ten o’clock her multiple pains were severe enough that she began imploring Chuck to call an ambulance. She wanted to go to a hospital.

“Linda, we’ve discussed it before, and you know there’s nothing they can do for you in a hospital,” Chuck told his wife.

But Linda would not be content. She told Chuck that she loved him and repeated her plea for an ambulance.

By ten-thirty Chuck was perplexed and afraid. He sat down in the overstuffed chair next to the couch where Linda lay and picked up the telephone. He dialed Cathy’s number. “I don’t know what to do. Linda’s in awful pain and she wants an ambulance,” Chuck told Cathy.

Cathy made several inquiries about Linda’s condition, then counseled Chuck to fend off the requests until the pain subsided, as it always had before.

“Just a minute,” Chuck interrupted, turning his head toward his wife. Linda had moved one foot onto the floor and attempted to pull her torso erect, as if to rise up from the couch. Now she sat in that position, stiff, with eyes and mouth wide open.

Chuck laid the receiver on the floor, then checked his wife’s respiration and pulse and looked into her eyes for dilation, as Cathy had taught him to do. In seconds, he knew that Linda was dead.

He picked up the receiver again. “Cathy, she’s gone. It’s all over now.”

Cathy counseled him to accept what he had known was inevitable.

“I’ll tell you what,” Chuck said. “You go to your icebox and get a beer, and I’m going to get some margarita mix we’ve got here, so I can get drunk.”

After Chuck had mixed his drink, he continued his conversation with Cathy. They planned out the steps that were required that night: telephone calls to a funeral home, to Chuck’s best friend, to Linda’s family. They hung up, and after he had made the phone calls, Chuck turned to look at the woman who only minutes before had been his wife.

“It’s hard to say how I felt, but I felt so, so alone,” he recalls. “I didn’t know what to do, so I tried to close her eyelids. I couldn’t get them closed, though, and I just sat there, not knowing what to do. Finally, about the time her family came in, I went into the bedroom and sat down and played the stereo with my headphones. It was a hard thing to handle.”

With Dave, the hospice social worker, Chuck visited the funeral home the following day. He selected a modest casket and looked at Linda.

“I wanted to make sure that she didn’t look worse than when she died, or else I wouldn’t have let her have an open-casket funeral,” Chuck says. “It was a good job they did. They stuffed her cheeks with something, so that she didn’t look so thin. She looked better than she had in months.”

After approving the morticians’ work Chuck went to the Buckner Baptist Childrens’ Home. The three boys were called into the chaplain’s office, where Chuck told them their mother was dead. All three wept, and one of them, who at times had beaten his mother about the waist, later blurted out, “It’s my fault, it’s my fault.”

Two days later the children were out in their Sunday best to attend Linda’s funeral, held on the fifth anniversary of her marriage to Chuck. The funeral was Baptist, simple, and well attended, like most services for the young. But it fell short, in some ways, of what Linda had wanted. She had requested that a popular country-and-western song, “I’ll Go to My Grave Loving You,” be sung at her service. Chuck could not arrange for it. Nor could he afford to give Linda’s grave a headstone.

Wearing a sport coat of his own and a pair of pants borrowed from his father-in-law, Chuck showed up at the funeral to perform the tasks the widower’s role required of him. But he was not comforted there. As soon as Linda was in the ground, he slunk off with Cathy, Dave, and a hospice volunteer—the people who he believed understood him best—for drinks in a Dallas restaurant where he and Linda had often dined. The four sat together for about two hours, reviewing the events that had brought them, a group of strangers, into familylike intimacy in the past weeks. By the time they left, all four were as clouded, and as comforted, as well-wishers at any whiskey wake.

Cathy Little, who had spent weeks preparing for Linda’s death, found that the memory of her patient was, in many ways, a personal one. “Linda had always wanted to go to Colorado, and Chuck always said that if there had been any way he could have afforded it, even after Linda got sick, he would have taken her,” Cathy says. “Well, after she died, I began to have the strangest new desire. I wanted to go to Colorado myself, as if for her, in her place. I haven’t gone yet, but I will.”

Chuck Mihlan has found solace hard to come by. For a few weeks after Linda’s death he turned to drinking—hard. At Christmas he carried a small tree with an ornament on top to her grave. There he broke down and cried for the first time since hearing Linda’s diagnosis. Social worker Dave Overton’s objective advice to Chuck was to seek out the company of new women, but Chuck spurned that counsel. Instead, he turned for consolation to the Pentecostal faith of his adolescence. In a world where youth, family, medical science—and even the specialized services of a hospice—are not as extensive or protective as we would like, Chuck Mihlan is finding a way to cope with Linda’s death: “You put your faith in God, you stay close to the one you love, and when she is gone, you pray that she is not alone.”

Related Content