A good life; a good death

I met Steve in L.A. I was grinding through internship at the county hospital. He was in the navy, working clinics in Long Beach.

We hung together during mutual times off. We relaxed, we played (in those days, these two activities were often one). Frequently, it was skiing. He also enjoyed surfing and was a tennis freak — two sports I avoided.

He was a muscular and lithe 160 pounds with little fat and lots of endurance. We both played chess. He taught me to understand — and appreciate — Bob Dylan. I thought he was the coolest guy I knew.

We also talked medicine. He had been a chemistry major in college. It was a relatively logical transition for him to the science of pharmacology in med school. And the logic continued into his chosen specialty of anesthesia with its split-second decisions about a patient’s needs and what chemical (medicine) will correct the problems.

He was a voracious reader of almost everything: fiction, history, biography and much more. But I remain most impressed by his constant gleaning of information from scientific journals, not only of medicine, but just about every branch of science.

He remains the most scientifically literate physician I’ve known. Every time we visited, he’d lay a few dog-eared magazines or stapled pages of articles on me, urging that I read them and tell him what I thought.

As we got to know each other better, he related that his parents had escaped Hungary as the Russians invaded. He was just two at the time. Like many immigrants, his parents struggled with the American form of English.

But his mother’s super-power was baking. She slowly built a company selling European baked goods and, eventually, frozen goodies. It put him through college and med school.

It also infected him with an appreciation of good food and with some skills in the kitchen. In the times we spent together, he sometimes cooked. The meals were often Hungarian.

He taught me a few kitchen skills and gave me an entire mason jar of paprika, assuring me that it would only last a few weeks. That “few weeks” jar is still on my spice shelf, six years later.

One long weekend after internship, when I was working in ERs and he in navy clinics, we and our wives drove my van to Baja California. At the northernmost reach of the Sea of Cortez were pristine, nearly deserted beaches.

Arriving in late afternoon after the long drive from L.A., we parked on the sand. The water sparkled — a million diamonds scattered over a vast silk of blue.

Warm white sand stretched far in both directions. We streaked for the water. He got there first and splashed in. Just as I arrived, he screamed.

He hopped back toward shore. “Sting rays!” he yelled. I looked down and saw dozens of pancake-shaped fish emerging from beneath the sand under a foot of water.

He had immediate pain. I helped him back to the van. But no dose of ibuprofen was going to be adequate for this. I’d been trained in SCUBA and had bought a book on First Aid for marine envenomation.

I probably got it out of concern about jellyfish. Luckily, it was in the van. Sting ray venom, it read, is inactivated by heat.

So we heated up some water on the camp stove as my friend writhed and spewed in what a physician would describe as “nociceptive intense” pain. Within a few seconds of submerging his foot in hot water, he stopped gnashing, his face relaxed and the afternoon was magical beauty again.

When he took his foot out, the pain returned, so we heated water while we cooked dinner until the venom wore off. The next two days we swam, floated in the dramatic tides that became swift rivers, were drenched by the sun, laughed.

The distance between Mariposa and L.A. is made much further by work schedules, so we didn’t connect often during those years. He lived in the poor section of Malibu — “Dogpatch” he called it — but to a mountain dweller, the rhythmic wash of Pacific waves was almost as soothing as friendship.

Maybe he’d tell you something similar about the exhilaration of hiking and biking in Yosemite.

The distance between youth and bodily deterioration is, on the other hand, shorter than we foresee or wish. He eventually decided to undergo major surgery on his back in an effort to eliminate pain from a distorted spine.

Too many crashes on skis and wipe-outs on the surfboard, perhaps. Plus a football injury in high school. I came to L.A. to drive him to appointments. The results were sub-optimal, and worsened by a car crash a few months later when someone blew a red light.

Then he developed early symptoms of Parkinson Disease. It was a slow progression, and medical chemistry helped. But nothing was going to stop that slow freight train.

He remained optimistic and scientifically curious, but he lost his sense of smell and, with it, taste. On one trip to L.A. during this period, he insisted on cooking for us, coping with his back pain. But he didn’t eat.

A few years on, he was diagnosed with Multiple Myeloma — a cancer of the bone marrow. More medical chemistry was administered to this medical chemist. But these were far more potent. As were the adverse effects.

Short and sanitized explanation — it messed up his intestinal system. I went down for a visit. His daughter from the Bay Area was there, helping him. She got little sleep at night because his damaged guts were tormenting him.

I told her to get a long rest in the second bedroom and that I would take the night shift. During the night he needed help getting to the bathroom. We almost made it. After I got him back in bed, I switched hats and cleaned up the floor.

His life became a semi-comical daily struggle with his intestines and unrelenting back pain. He realized he couldn’t live alone any more (his wife had died a few years earlier), so we loaded up his car and drove to his daughter’s place.

As usual, he had some articles for me — this time on the difference in brain function between sleep and anesthesia-induced unconsciousness, on climate crisis and on promising new changes in nuclear energy.

Down to the absolute basics in life — everything fit in his car — he created a nest in his daughter’s house. The new grandchild added joy and he helped his daughter and her husband as he could.

But he had left valued old friends “down south.” A year or so into his Bay Area life, we drove to L.A. A mutual friend and internship buddy organized an afternoon party with all Steve’s friends. Next day, there was a poker game. He lost $2.45 and laughed most of that afternoon.

When he got to the point of needing a walker, even in the house, the possibility of him driving up to Mariposa was out. If I had business in San Francisco, or when I had time to make a trip, I’d go because I was his closest friend, geographically speaking.

On one such a visit, I talked him into going outside and wheeled him through the Berkeley Botanical Gardens until his back pain begged for relief. At least this beach boy got some sun.

Three of our mutual friends texted him saying they were coming down (“up” depending on how you hold the map) the next week. He invited me to join them.

My first reaction was to demur — I don’t relish the drive that much, and without me, he could focus on them. My second reaction had me there the next week.

He walker-shuffled his slow way to the sofa, swallowed his pain pills on routine schedule and enjoyed everyone’s chatting. He didn’t speak much because the Parkinsonism made generating vocalizations very difficult. And very exhausting. His eyes closed and the rest of us re-visited memories for him to listen to.

At one point, he opened his eyes and asked me to go with him to the bathroom. I helped pull him up, he grabbed the walker and it was shuffle, shuffle down the hall. I stayed right behind, ready to catch him if he stumbled (he was down to 120 pounds).

He wanted me to stay in the bathroom while he leaned on his walker, straddling the toilet, his arms quivering. Clearly, he didn’t trust his body. We got him back to bed and said our good-byes. He grinned and told us how great the day had been.

His daughter called me a couple of days later to relay that he’d decided he’d had enough. He wasn’t going to get better and he didn’t want to be a burden. They brought in hospice.

The hospice physician consulted with him. There was paperwork. They arranged for him to obtain a cocktail from a specialty pharmacy.

More medical chemicals — this time a much larger dose than we’d ever use on patients, and several different chemicals (medicines) we’d never use together. Except, of course, in this circumstance.

He spent some intense time with his daughter, his chihuahua, his grandson. His grandson went off to play. He drank the cocktail and went to sleep.

I don’t know how many patients he helped over the years. Don’t know how many times he taught someone something. Don’ know how many paprika-sprinkled meals he made for people. Don’t know how many adventures he shared with others.

But there’s a lot I will always remember because it’s all become part of who I am.

Dr. Charles Mosher, M.D., M.P.H., was Mariposa’s county health officer from 1988-2014. Prior to his work at Mariposa County, Mosher served in the Peace Corps, worked for the state of Georgia and served for 11 years with the Merced County Health Department. He can be reached at author@greaterstory.com.