Physician's Notebooks 10 - http://physiciansnotebook.blogspot.com - See Homepage
18. Deathwatches - Update 23 Septr 2021
18. Deathwatches - Update 23 Septr 2021
My Father
My Mother
Brother Allen
Brother Joe
My 1st Wife, Riyo
My 2nd Wife, Etsuko
Cousin Dan's Wife Margaret
My Boyhood Friend Ivan
My Father
My Mother
Brother Allen
Brother Joe
My 1st Wife, Riyo
My 2nd Wife, Etsuko
Cousin Dan's Wife Margaret
My Boyhood Friend Ivan
My Father
Born in 1895 in the Austro-Hungarian Empire, his birthplace today the western Ukraine, my dad was Palestine USA Battle USA, in
Dad, after making Certified Public Accountant, became a lawyer and in 1931 jointly founded a law firm at 29 Broadway in Manhattan. From 1936 to 1963 he, Mom and we 3 brothers lived in a 1st floor, 2-bedroom apartment in the Bronx NY. From 1963 he lived with Mom in a 1-bedroom at Long Beach, Long Island NY. His height was 67 inches (1.7 meter) and by today's standard he was a little overweight. In 1965 one day he complained of chest pain and test showed a myocardial infarction heart attack. He was in hospital a week and also showed diabetes type 2, and a mild high blood pressure.
He continued successful law practice and enjoyed life with my mother.
He continued successful law practice and enjoyed life with my mother.
One afternoon in fall of 1969, I got call from Mom that Dad could not pass his urine. Arriving at their apartment, I found Dad moaning with obstructed bladder from enlarged prostate. I took him to my hospital's private urologist. (I was then a senior resident at my Hospital.) He did surgical prostate removal through abdomen. It is a bloody, long operation and afterwards the patient is left with a tube connecting the stump of his prostate urethra with distal urethra, and recovery takes 3 weeks with pain and problem of blood clot blocking the tube. Dad had an unpleasant post-operative period and a week later his heart started irregular beating of atrial fibrillation. It was treated and after weeks the heart rhythm became normal but he remained weak and I decided to take him out of hospital to my apartment where my wife and I took care of him for a month, nursing him back to health and strength. It was February 1970, and dad, who'd lost 30 lbs (14 kgm) during the hospital experience, was able to go home to Mom in Long Beach
Late summer 1970, hot: Just as night falls, the NYC area is hit by a power failure. The power restored after 30 minutes and I get call from Mom reporting Dad got excited because of the power failure – he was agitated and angry, and now he cannot breathe well. I drive from my home. Coming out of elevator onto 5th floor hall at end of which my parent's door is, I hear Dad's loud groaning sighs. Inside, I find him lying on the sofa breathing rapidly and Mom sitting helpless. He is in severe heart failure. I reach in my bag for pre-syringed 10 mg morphine sulfate (MS), pull off rubber needle guard and inject the MS slowly into a bulging vein in his right elbow. In seconds as the drug reaches his brain, his breathing slows, he smiles at me weakly, says softly as he contentedly exhales “Mein son” (His middle European English for “My son”), and then stops breathing.
I do not do mouth-to-mouth resuscitation or call an ambulance, because several months earlier, as I took him from his last, worst hospitalization, he'd said, “I'd rather die than go back in hospital.” The morphine injection, part of the treatment of the pulmonary edema of acute heart failure, risks stopping breathing. As required with death at home, I call the police and 2 detectives come and ask questions. An autopsy is not required.
I do not do mouth-to-mouth resuscitation or call an ambulance, because several months earlier, as I took him from his last, worst hospitalization, he'd said, “I'd rather die than go back in hospital.” The morphine injection, part of the treatment of the pulmonary edema of acute heart failure, risks stopping breathing. As required with death at home, I call the police and 2 detectives come and ask questions. An autopsy is not required.
Critique: Immediate cause of death was probably the Morphine but basic cause was acute heart failure due to chronic coronary heart disease. Dad at age seventy-five years and 7 months at death had lived longer than his life expectancy when he was born. (A person born in USA in 1900 had average life expectancy 47 years.) But he could have lived even longer than he did. During his life, there was no emphasis on keeping the weight, the blood cholesterol and the arterial pressure low, which would have given dad more good years. His prostate surgery was unnecessarily extensive. Single episode bladder obstruction from prostate at most should require the less-invasive transurethral resection.
If Dad had cultivated meditation ("simple", not "transcendental") to avoid anger in the face of frustration, he might not have been thrown into his final, fatal heart seizure.
Comment on my behavior: From my psychoanalysis I understand I had ambivalent feelings toward my father: Both love and the subconscious wish to see him die to make way for the new generation, and it tended to make me not pay as good attention to dad's medical care as I should have.
My Mother
Anne Spunt Stim, my mother, was said to be born 1901. She died in 1975 in hospital of heart failure.
Typical of women of her generation, she would be considered a bit overweight now. I recall her as a little weak in the lungs because she tended to cough easy. Sometime in late 1960's, I have a memory of Mom and Dad returning from a flight at JFK airport and I noticed Mom in heavy mink coat breathing heavily as she tried to keep up with Dad. Far as I know, she'd never been examined until one day in 1973 I got call from my brother Joe that Mom had got suddenly short of breath shopping in Long Beach NY Long Beach Bronx . She did not like it. Then I convinced her to go into hospital because I had the idea her heart failure could be better regulated there. In hospital in winter the flu was going around and she got it and died.
Critique: Again, in my opinion, we see, as with Dad, a genetic or cultural programming whereby the younger generation subconsciously kills off the older. I did not pay enough attention to the best decisions for Mom's health. I should not have pushed her into hospital, which killed her quickly. More careful control of her heart failure by world-beater cardiologist and good medicine and more home help would have given Mom more good years.
Brother Allen
Allen was born 1 April 1920, first child. He was the heaviest of my brothers. I estimate Allen's BMI ranged from 25 as young man to 26 before illness. Late in life he had hypertension and prostate enlargement. Early as 1992, blood test showed starting kidneys failure by rising creatinine (Cr) 2 mg% (normal up to 1 mg%). On 3/18/97 , his was Cr 3 mgm and an X-ray of kidneys showed shriveled kidneys with bilateral cysts. Allen considered his kidney disease as due to his World War 2 army tank service, an effect of its strong vibration. I first learned of his kidney failure on 4/8/98 when his blood Cr was 4.5 mg% and the diagnosis “apparent chronic renal insufficiency.” Since imaging revealed small kidneys, it was chronic renal disease, and the blood test showed high potassium (hi-K+, hyperkalemia) and an anemia typical of chronic kidneys failure.
Downward Course of the Renal Failure: Allen was against pursuing the original cause of his kidneys failure because of his old age and advanced stage of shriveled kidneys that made biopsy risky. He began kidney dialysis September 1999 after having a forearm shunt placed when his blood test Creatinine reached 6 mg%. He had 3 to 4 hemodialyses a week. In March 2000 he had to stop driving cars. I saw him on 12 March 2000 . He seemed his usual self then. But in the fall of year 2000 he had developed dementia. (After only 1-year dialysis it suggests dialysis dementia.) In nursing home, in April 2001 he fell out of bed and fractured his hip. (The low calcium of renal failure favors severe osteoporosis and fracture.) Then on 9 May 2001 , 9 yrs after Cr was 2 mg%, 4 yrs after it reached 3 mg% and 3 yrs after it was 4.5 to 5 mg%, Allen died in the nursing home and no postmortem exam.
Critique: Allen, by living to age 81, did well in expected life at birth in 1920 NYC (56 years), but more aggressive efforts to prevent or slow kidney failure might have given him several more years of good life and possibly avoided the dementia.
As far back as 1992, when he first got blood test showing Cr 2 mg%, he could have had a major check by kidney experts to find out why at age 72 he was developing early kidneys failure. Include kidney biopsy, CT or MRI, and analysis of kidney function and level of failure. Then, a diagnosis of cause and mechanism of kidney failure could have been made. After such check even in best hands all answers may not be discovered. Maybe, a prevent program starting in 1992, would have avoided dialysis. Such a program should have included: rapid treatment of obstructed prostate to relieve back pressure on kidneys, avoidance of NSAIDs (aspirin, and the many like meds such as Motrin and Advil), a nutritionally balanced low protein, low sodium, low potassium diet with attention to adequate calcium and vitamin D to avoid osteoporosis, and a high water intake. The liver toxic drug colchicine, which he was given against his gout, should have been avoided; rather use Zyloric to keep blood uric acid level from stone forming highs. Blood pressure should have been normalized medically.
In our real world, Allen's attitude is typical in the old person who takes a fatalistic approach. I am not saying the attitude is always wrong but I think one should give a mortal illness my one good college try.
Brother Joe
Joe: born 6 March 1924 . Since youth he had Chronic Obstructive Pulmonary Disease due to allergic asthma (Never smoked), giving him a barrel chest but he lived to age 79 even with hypertension and heart arrhythmia. A good, active life!
In 2003 Joe's oldest child had a marriage celebration. She lived in San Francisco 3 Nov. 2003 at 11:07 AM . (From the certificate that lists “severe coronary atherosclerosis” as “other condition”.) It was a tragic accident because Joe was a vital intelligent person, and it points the lesson that when you are lucky enough to reach age 79 on your feet with wit and wits, don't engage in unnecessarily risky activity.
My 1st Wife, Riyo
Riyo was born 3 December 1917 in Hokkaido Japan 21 June 1954 in Chitose. I was a 21 y/o US USA
Over years starting 1956, I had her seen by an internist M.D. but she was treated not very effectively with anti-hypertensive medications.
She gave evidence her heart was being badly affected, by an arrhythmia at home in 1974, and in 1981 on trip to Japan
Riyo started experiencing menopause in her late 40's and I proposed she do Hormone Therapy (HT). As a woman with 17 year/old younger husband she went for it. I followed her hormone blood level and when it indicated deficiency state she started estrogen as Premarin 1.25 mg cyclically, added to for last 10 days with Provera 5 mg to regularize menses. She continued this until her death (for 15 yrs). Its physical effect was good; right up to the end Riyo looked 10 yrs younger than actual age, and felt it too. (Her Japanese daughter commented that at the funeral, Riyo's bones were very white, a good effect of HT.)
Critique: in retrospect and considering Riyo's high cholesterol and Coronary Artery Disease, I did not take seriously enough the pro-blood clot effect of the estrogen Premarin and the bad high cholesterol effect of the Provera. Today, I would have used half the doses I used then and added a Statin lower cholesterol medication.
Critique: in retrospect and considering Riyo's high cholesterol and Coronary Artery Disease, I did not take seriously enough the pro-blood clot effect of the estrogen Premarin and the bad high cholesterol effect of the Provera. Today, I would have used half the doses I used then and added a Statin lower cholesterol medication.
Riyo could be still alive, had I paid better attention to her hypertension from the start. In 1960, I should have brought her to the Mayo Clinic or other world-beater place for hypertension workup, which might have found the cause of her hypertension and also evaluated key target organ damage – in heart, brain and kidney – from hypertensive standpoint. Then, careful application of low-sodium (Na+), good calcium diet plus medicinal strict normalization of BP and better attention to cholesterol levels (her TC was over 200 when I first noted it in 1980) would have prevented the advance of coronary artery disease. And when she showed signs of heart disease in the 1970s, a coronary angiography should have been done and the artery obstructions should have been treated with angioplasty stenting or surgically bypassed.
Here is a case of family member giving medical care carelessly. One motivation was my subconscious wishing Riyo would die so I could be free. Once again we see, as in generational antagonism, the influence of a caretaker not self-psychoanalyzed and not understanding, or not aware of, motivational ambivalence. If psychoanalyzed successfully then, I would recognize my irrational motivation and have moved to preserve and prolong Riyo's healthy life. Actually she was a fabulously good wife I had been extremely lucky to find, and I have missed and needed her much over the years.
The My Boyhood Friend Ivan
Ivan was brought up by a single, divorced mom in nice apartment near me inBronx . (Commonly done then by divorced couples; at least 2 of my childhood friends!) As I did, he attended public schools and grew up on Bronx streets. He was a healthy kid. He went to University with me first year and then was drafted into US Army and spent a year in Japan Greenwich Village . The marriage fell apart and Ivan began his migration from USA, France Israel,
My 2nd Wife, Etsuko
E. born 24 January 1941 ; we married (She for first time and never pregnant – a risk factor for breast cancer), May 1986. She had good health and never smoked but did drink before we met – a small bottle of sake a day (Another breast cancer risk factor). In late 1990s she asked me to examine her breasts. I found both lumpy but without dominant lump and I thought it cystic mastitis and reassured her and did not suggest she get mammography.
On 15 March 2001 , she became worried about her right breast. She went to nearby hospital and saw the surgeon. He did needle biopsy; his report said cancer. The surgeon scheduled a radical mastectomy. The day before the surgery, he assembled E's family including me and explained the surgery and, at end, said the CT showed a metastasis (Met) in liver. I was shocked to hear it because I had learned mastectomy is only done for cure. I passed a letter to E explaining and advising she cancel the tomorrow surgery and I would take her to National Cancer Center Tokyo
On 17 May 2001 , E. made first visit with the oncologist who examined her and noted 7 x 5 cm tumor right breast (Based on size of tumor, worst prognosis). Multiple needle biopsies were done under ultrasound. We were told, next visit 2 weeks later, it was adenocarcinoma. Hormone receptor test of the tumor cells was negative. At the time I was not knowledgeable and did not carefully inquire into ER, PR and ERBB2 receptor status but it ruled out hormone treatment. The breast cancer was incurable (metastasis) stage IV to liver so the advice was chemotherapy which extended over several months and was administered outpatient at the Center by intravenous. Etsuko lost her hair from it but later it re-grew. It made her feel nausea and weakness. Also it depressed her brain making her forgetful.
Blood Tests Predicting Course of Illness: At start, E's blood tests were normal but the WBC and RBC dropped due to the chemotherapy. At worst, on 21 Aug 2001 , the WBC was 1700 per cu. mm, and Hct 26.8%. (Both rather low) She tolerated the low RBC and low WBC with no infection, taking usual precautions (mask, antibiotic course, careful hand washing, staying home with few visitors). Her serum albumin, a measure of protein malnutrition, did not become low, until 13 September 2002 near the end, when it dropped below normal 3.7 g/dl to 3.4.
She was menopausal at age 60, and blood tests on 2001/5/18 showed Luteinizing Hormone 58.8, Follicular Stimulating Hormone 79.0 (both post-menopausal high) and Estradiole ovary hormone below 10 (low female hormone as expected for age 60). Her liver enzymes showed gamma-GTP most sensitive, rising, from normal in May, to 71 on 8/14, to 105 on 9/4, to 112 on 9/11, to 120 on 9/18, and on that day the AST 45, ALT 37 (the AST & ALT are liver enzyme blood tests that rise into the 1000+ units in hepatitis and also rise with metastasis to liver). The Alkaline Phosphatase (ALP) 344. (ALP was her first abnormal high level of liver-damage marker enzyme; a sign of metastases to liver or bone.)
The blood test total bilirubin (yellow liver pigment that causes jaundice look) remained normal until 2002/9/13; then it was 1.9 mg% and she became mildly jaundiced. She died 10/16; so, with liver metastases, an elevating bilirubin probably signals the end within 2 mos. The anemia was macrocytic, hyperchromic, the result of chemotherapy since it waxed and waned with the white blood cell count according to the level of chemotherapy.
The blood test total bilirubin (yellow liver pigment that causes jaundice look) remained normal until 2002/9/13; then it was 1.9 mg% and she became mildly jaundiced. She died 10/16; so, with liver metastases, an elevating bilirubin probably signals the end within 2 mos. The anemia was macrocytic, hyperchromic, the result of chemotherapy since it waxed and waned with the white blood cell count according to the level of chemotherapy.
Comment on the Blood Tests: My observation from E.’s case is that breast cancer patients have too many blood tests. The tests should be the minimum necessary for evaluation because they add to anemia.
Response to Chemotherapy: E. showed no response in the tumor, and her liver enzymes rose during and after chemotherapy courses suggesting inexorable growth of liver Met despite chemo.
Particular problem was progression of tumor in right breast, which drained pus and pained and required frequent dressing change. It seemed to be unaffected by the chemo. In retrospect, I would advise simple tumor-removing mastectomy early-on for prevention of local tumor necrosis. (So the original surgeon advice for mastectomy although not curative would have been best for comfort) Actually recent data show that even with incurable breast cancer, mastectomy improves survival and quality of life. But it should be simple, not radical.
Etsuko lived her last 19 months after discovering tumor between home and at the Cancer Center involved in chemotherapy until Dec. 2001, when the chemo was given up as failure. From then she visited the Center monthly for blood tests on progress of disease.
In spring 2002 she heard about Maruyama vaccine. (Immunization against cancer with an extract of BCG TB bacteria that patients self-administer by injection 3 to 4 times or more a week.) She did it from March to September 2002 with no effect.
She did not complain of strong pain, but was bothered much by discomfort from her right breast pus skin breakdown. In September 2002 she developed ascites (tense abdomen swelling from fluid dripping off her liver from the Met) and it was uncomfortable and she needed a needle tap of several liters which relieved her (And immediately caused a huge appetite which satisfied in the cafeteria!) but from then on she got progressively weaker and in late September entered hospice care and died, assisted by physician-given morphine sulfate drip on 16 October 2002. (For the fictionalized death scene, click 11.38
Cancer 3 - How to Die in Japan ).
Critique: Most basic is that E, a 60 y/o woman should have been getting annual breast screening since age 40. Had she, the breast cancer would have been picked up years earlier. Lesson is: not to depend upon physician family member to determine your diagnosis and treatment.
If we put ourselves in E.’s body on 01 April 2001 , we see incurable breast cancer with liver met with poor prognosis because of negative hormone and chemotherapy receptors, and we estimate 1 year of life. Goal should be to prolong effective, relatively pain-free, ambulatory life.
In liver metastases breast cancer, an initial aggressive approach to the liver Met could have been considered. If survey tests show only a few identifiable liver Mets and patient has strong reason to want cure, I would consider a laparotomy (upper abdominal opening) to directly check on the metastases to the liver and, if only a few ones, to cut them out. (But only if there is very strong reason to keep on living.) Also, a careful measurement of the ER, PR and ERBB2 receptor levels of the local breast tumor and of the Met should have been done and, based on that, the correct combination of chemotherapy and monoclonal antibody might have given good quality of life survival.
When a cancer reaches the stage that E.’s reached in 2002 with failure of initial attempts to limit or minimize Met, the best approach in my opinion is for the patient to stop curative treatments. (Of course decided on by the patient after wise advice and with good psychoanalysis.) The possible mode of death ought to be considered and, when it seems soon, the least problematic one aimed at. Appropriately timed assisted-death by morphine is one route. Once effective treatments have been exhausted, the patient should be allowed to live as pleasurably as she can with minimal or no precautions and no further testing. She should be allowed opioids. An ideal society ought to have education instill a sense in the dying person to give caring thoughts to her caregivers. For example, to shield children from seeing a parent reacting like a child toward her approaching death, and to not forget about the mounting financial costs to the family for useless, expensive modern cancer care. But the society should also support the dying person by free care and relieve all financial burden
Cousin Dan's Wife Margare was born in 17 Dec. 1929 . She had good physical health. She was a non identical twin and her twin sister had schizophrenia which may be relevant to her ignoring of warning signs because she was eccentric. Around January 2009 she first mentioned to Dan she saw blood in her stool. He suggested she get it checked but she feared that. By June 2009 she had become dirty and smelled bad and ruined sofas she sat on. Dan finally insisted to bring her to the local emergency room where they discovered a hemoglobin 8 gm per dL anemia. She was admitted to hospital and a sigmoidoscope showed cancer involving several centimeters of rectum but no metastatic disease. Her tumor was too large for surgery so the cancer expert advised debulking the tumor (making it smaller) by chemotherapy and x-ray treatments and then a distal colectomy (cutting out of the end of the colon including rectum) with colostomy (an opening for feces passage though abdomen). She refused out of fear and I supported her refusal because of poor chance of cure with such a tumor and, even in the case of cure, the heavy burden of side effects of radiation and chemotherapy plus the major surgery and the continuing care needed for colostomy. Margaret's bad mental state could not tolerate it.
She was put in Nursing Home/Hospice in late July 2009. On her 80th birthday, 17 Dec., we visited and Margaret appeared very aged. Again we visited 1 Jan., and she was sleeping in curled-up position on her left side but she could be awakened and got alert enough to speak and understand. On 14 Jan., I noted aspiration into lungs and on 15 Jan. we got a call, 6 PM, that she had stopped breathing. Dan did not know what to do. Finally a call on the weekend, 2 days later, said Dan must get a funeral home to take the body. He did, and eventually she was buried and he got a bill for thousands of dollars. It would have been better to have gone down at once on her death and arrange for transport to local cemetery and cremation there by the cemetery for $400.
Critique: Even in the late case of this rectal cancer, a mentally-together person could, with good management, have had a good year, and death could have been managed at home at much less cost to family. {For a fictionalized experience from Margaret's death that teaches how to handle such an event well, click 12.(46-51):
Deterioration, Death, Disposal, Denou... })
The My Boyhood Friend Ivan
Ivan was brought up by a single, divorced mom in nice apartment near me in
We kept in touch by mail and internet and I visited 3 times in Israel - the last time, Aug. 1996 -
2008.01.17 2008.02.22 2009.11
Cholesterol: 328.30 241
HDL-Cholesterol 74.75 (65) 99
LDL-Cholesterol 236.21 159 236
Triglycerides 86.72 c.86 (Simvastatin 20 mg a day)
Took Lipitor 20mg per day, increase of ten mg; till 2009. Now Simvastatin.
I suspect that because he is a painter he had a toxic lead Pb, cadmium Cd and/or mercury Hg neuropathy but he never did tests. Clinically Ivan was remarkably healthy considering his age, the high cholesterol, and the diabetes. His mind perfectly preserved like it was when he was 20 except more mature.
I suspect that because he is a painter he had a toxic lead Pb, cadmium Cd and/or mercury Hg neuropathy but he never did tests. Clinically Ivan was remarkably healthy considering his age, the high cholesterol, and the diabetes. His mind perfectly preserved like it was when he was 20 except more mature.
Email from Ivan on Wed, 2009.11.18: Stim kid, good to write you once again but it takes me time to use the computor (sic) beause (sic) I do so infrequently. I prefer letters where I can toss in a drawing to enhance my point and make the thing somewhat richer. So tell me your address again but not the Moshalu (sic; should be "Mosholu") parkway bench or giant stone near the Jerome Avenue
My neuropathy is about pain in trhe (sic) legs and some inbalance (sic) but not when I danxce! (sic) The diagnosis, whci (sic) took years to obtain, is that I have a rare neuropathy of destroyed little nerves in my legs caused when I fell down my mountainside almost 8 years ago. The 4 "ropes" above the knee where (sic) torn. The first surgery might have been too light so it tore again. The second operation has held and my leg always improves, enabling me to walk stretches of 4-5 miles. I can jog just a bit. For pain when it comes, not upon awakening, I take oxy-contin, (Ed: a popular opioid) 10mg, about 3 times per day. Fine drug. There is no pain when I sleep, which is apparantly (sic) vey (sic) lucky. I have no sugar by (sic) there's high cholestrol (sic) for which I take a drug. For the neuropathy I take Lyrica, 75 mg, and Cymbalta, 30mg.
In truth my painting is the best medication and I've been extremely productive these last years with earning power.
However I am essentially a recluse, spending my days in the studio, alone. Lately to cheer myself up I paint Charlie Chaplin. My paintings are so varied because I respond to each subject with all its multiplicities yet with the force behind classical balance.
I say this knowing you are not adept in the arts but we've got a great friendship and that's what counts.
Schwerbelblitz (And see HDL and LDL on Simva 20 mg in above chart)
I got another email in May 2010 and Ivan was fine. Then in spring 2011 he reported he was badly depressed. Finally, I called 2011, 10 July, and only got a recorded announcement. The following from his wife:
I got another email in May 2010 and Ivan was fine. Then in spring 2011 he reported he was badly depressed. Finally, I called 2011, 10 July, and only got a recorded announcement. The following from his wife:
He died while taking his daily walk in his favorite place, Nahal Sorek, a beautiful wadi (dry river bed) nearby which he painted for the last three years. He called it "the safe place". We don't know yet the cause of his death. But there were no signs of violence and it didn't seem like he fell. He had his wallet and car keys in his pockets. Maybe it was a heart attack or a stroke. Results from the autopsy will come later on.
.....
That morning he worked on a new painting, had his coffee and read the paper, and then went out for his walk with our dog Shuki. In his car was a letter addressed to his friend ... in California, which apparently he intended to mail after his walk - the last letter he wrote. The letter was ordinary, business as usual, with plans to travel to Greece in September together with me. Schwebel was doing relatively well in the last couple of months. Some time before that he had had a bad fall down a staircase. His equilibrium was not good, and got a bad wound in his head, which had to be stitched. After that it took a long while to recover. But he did. He began new medication for his neuropathy, and was taking anti depressants. He was painting like mad in the last weeks, and making plans for new shows. (Ed: Did he subliminally come to realize he will die soon?) I take great comfort in thinking that he died in the midst of his creative process, while he was still healthy and in a clear mind.
Ed comment: His sudden death probably due to heart arrhythmia. Looking at what he had in the morning, the risk factors are: the strong coffee, the anti-depression and the neuropathy medications probably taken before his walk, and the walk itself that may have caused some increase in demand on heart. His high cholesterol and diabetes also made him susceptible to coronary artery blocking heart muscle disease.
Preventive suggestions for us old persons from this case are: If you are going to go for a walk, before starting out, no morning coffee or morning medications, and be very careful about medications and dose. I think anti-depression medications are too highly dosed and heart seizures are one of their complications. And, keep total cholesterol below 150 mg% and LDL 60 or less.
Ivan lived a good life and active till the end so luckier than most but I think he could have had another good 10 years painting and enjoying.
Follow up on Ivan: On 13 March 2012 I got an email from his wife telling that the autopsy revealed a "heart attack"and coronary arteries were "70%" obstructed. Strictly speaking, 70% obstruction of a coronary artery is not necessarily the cause of a myocardial infarction heart attack but it could be, especially if more than one coronary artery had the obstruction and he was exercising.
To see a resume of Ivan's paintings, go to http://www.schwebelpaints.com.
Ivan lived a good life and active till the end so luckier than most but I think he could have had another good 10 years painting and enjoying.
Follow up on Ivan: On 13 March 2012 I got an email from his wife telling that the autopsy revealed a "heart attack"and coronary arteries were "70%" obstructed. Strictly speaking, 70% obstruction of a coronary artery is not necessarily the cause of a myocardial infarction heart attack but it could be, especially if more than one coronary artery had the obstruction and he was exercising.
To see a resume of Ivan's paintings, go to http://www.schwebelpaints.com.
Addendum: here below is Ivan with his self description.
Ivan Schwebel
Born in West Virginia, October 29, 1932, then raised until six in Cochran, Georgia. A divorce bought (sic) my mother, my two older sisters and I to the Bronx, Gates Place, opposite Van Cortland Park, where I was raised until breaking out to play baseball, study acting (Ed: In uptown NYU, 1951-2) and go to the army during the Korean War. I hardly ever saw my father who had substituted his Yiddish-Polish accent for a southern drawl very quickly. People actually paid to hear my accent when I was 6.
At 19, The US Army was like a grant for me. I was sent to Japan when the war ended in Korea. There, after telling an officer some nonsense about my journalistic experience, I spent almost two years in Public Information. Japan thrilled me. It awakened talents that lay buried for several years. I began to paint and managed to study with a Zen master-painter, Kimura Kyoen in Kyoto. “Study” is incorrect. The man loved me, even showed my work in a giant temple because my black and white brush drawings contained nothing of traditional art. It did have the excitement achieved when one draws without preconception. The Army kept giving me leaves to be rid of me. I often lived in a Buddhist temple run by an woman priestess whom I loved. A painting of her and I is in “Models”.
I returned to N.Y. considering myself a painter but was frightened to just do it, so with the GI Bill I went to New York University. There I met Philip Guston who told me it’s best not to teach painting because it could waste you. Therefore I studied art history while painting at night. After the B.A. I went on to the Institute of Fine Arts for three years. I quit just before my M.A.
I left N.Y. to get my son from the my wife’s Greek family in Sparta. I failed to achieve this so I bounced around Europe for a year. I came to Israel in the winter of ’63 and have remained ever since. My hillside home and studio in the outskirts of Jerusalem was found immediately, as was another wife. After ten years we had two children. My wife died in 1989. I since remarried, making two more children.
I have actually taught drawing, very recently for two years, convinced by my wife to do so because “there are beautiful girls there”. What soon occurred was that I grew fond of the youth of Israel, kids back from the hell of military service. I got fired because I gave everyone a 97 regardless, except one. He got 98 because he brought two bottles of wine to our end-of-year party. I made them 3 big exhibitions of their works on hate and the torments of the times to insure they knew about the serious potentials of painting.
Yearly I and family visit N.Y. for a short spell. In the early 90’s I even took a loft on 20th Street, painted and managed to pay expenses through the sale of paintings. However, the scuds of the Gulf War and the births of our children made trips impossible. Had I an agent, perhaps I would have maintained it. But I have not met the agent or gallery that could sell Houdini self-liberating while suspended over Canal Street, or the Bronx stick-ball three sewer hitter, especially since my work fits no popular style or fashion. And who’s to handle David fighting Goliath on Times Square?l
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