This is Tom Birchler’s account of Bill Birchler’s fight for life. He did it with incredible determination, with humor, and dignity.  It is important that people know how he fought through such a difficult time, while making the people close to him feel at ease and with hope.  This is an account of a person trying to live with everything working against him:

 

10 Jan: Ann, Dad and Molly go to Bill’s house in the afternoon to see if he is okay.  He has been reclusive since everyone has been concerned about his health; but he does not answer the door.  A locksmith and police are called. Once they get into the house, Bill is in the Rec Room, lying on the couch, unconscious.

 

Bill is taken by ambulance to Alexandria Hospital about 5 PM.  The rest of us wait at the emergency room.  By 7 PM Dr. Asia tells us that Bill is stable, is going to be okay, but has major liver problems and will be in the hospital for several days.  Several doctors begin talking to everyone asking about lifestyle questions; medication questions, alcohol consumption questions, etc. trying to determine a cause for Bill’s symptoms.

 

They are asking about Bill taking medicine and are very interested in whether he takes Tylenol, which can severely harm the liver.  They tell us that someone needs to go through his house and see if he has anything that would contain Tylenol.  I volunteered and went through everything; I only found some aspirin in his bathroom.  There were some empty bottles of Nyquil in the trash, so it is assumed that was the cause of Tylenol in his system.  I think everyone is in shock over the news; it is hard to believe Bill is so sick.

 

By 10 PM Bill’s condition is much worse and is transferred to the Intensive Care Unit.  Bill is comatose and not responding.  He is wearing a neck brace that the paramedics put on him when they found him at the house.  They do that as a precaution, since they did not know if he was in that condition on his own, or if he was attacked.  It makes him look very uncomfortable, and the nurses tell me they can not take it off until after he gets a neck x-ray to make sure he did not get any trauma to that area.

 

Bill is bleeding internally, causing his BP to be low, and cannot breathe on his own.  Dr. Levinson, a Gastroenterologist, is convinced that Bill has cirrhosis of the liver, and that is causing the bleeding, which is coming from the esophagus (variceal bleeding).  She describes a procedure that will stop the bleeding by injecting a drug into the veins to contract them (endoscopic sclerotherapy).  She says she needs to wait until he is more stable before performing the procedure, hopefully sometime during the next 12 hours.

 

11 Jan: Dr. Levinson calls at 4 AM to say that she has performed the procedure, but she could find no bleeding from the esophagus.  This rules out cirrhosis of the liver.  The bleeding is most likely coming from the stomach, but the endoscopic sclerotherapy procedure is not effective in the stomach.

 

At the hospital in the morning Bill is comatose and hooked up to life support.  He is loosing a lot of blood and the liver is not producing the coagulants necessary to stop bleeding.  Dr. Kim tells me he is “bleeding like a sieve”.  The doctors tell us that his only hope is to get a liver transplant; his is barely functioning which has strained his other organs and they are not functioning properly.  They are trying to get Bill admitted to Fairfax Hospital because they do organ transplants and he would be one step closer.

 

In the afternoon the doctors are telling us that they are trying to get Bill admitted to MCV Hospital in Richmond.  They are able to do a procedure there that helps treat liver failure by injecting spleen cells into the liver.  Once MCV agrees to take Bill, they send a helicopter to Alexandria Hospital for him.  The ICU staff react that Bill’s getting into MCV is a major success, so we all are feeling more optimistic.  Dad and Molly head down for Richmond and I leave about 5 PM.

 

When I arrive at MCV Hospital, Dad and Molly are talking to the ICU doctor, he is explaining the dire straights Bill is in, and how most of his internal organs are not working, as a result of the liver failure.  He tells us “if there is anyone who would like to see Bill, they should come here now”.  They will continue to do tests overnight. The feeling of optimism is now gone, since the doctors are not giving us much hope.

 

12 Jan: We wait at the hospital for most of the day and spend time visiting Bill and reading the newspaper to him.  There is no more information on his condition, other than it is not improving.  The liver procedure mentioned above is not an option, due to how bad his condition is.  The doctors do not believe it will do any good.  Bill is still comatose and bleeding internally, he is connected to a ventilator; they are using medication to keep his BP at a safe level.  His abdomen is swollen with fluid (ascites) and there is considerable swelling in his legs (edema).  They have his legs in pressure cuffs, which inflate periodically in order to keep his circulation going to his extremities.

 

Sook and Melissa came down to visit and attempt to give Bill encouragement.  We hope that he can hear everyone who is visiting, but he is not responsive at all.

 

Cousin Frank Flynn and Aunt Kit also come down to visit this evening.  It is very comforting to have them there, even though he is not responsive.

 

We spend much of the day letting everyone know about Bill’s condition and to come and see he him ASAP as the doctors told us.  It is hard to believe how messed up he is.

 

13 Jan: There was more waiting at the hospital, with no more information from the doctors.  They continue to monitor Bill’s condition to see if he responds to the treatments they are giving him.  Doug Watts came to visit and so did Tom and Stephanie Flynn.  In the evening the doctors brought the family into a consulting room and explained that Bill is not responding to the treatment, and may not have much time left.  There will have to be a decision to stop treating his illness and begin trying to make him comfortable, which means he is going to die.

 

The doctors tell us that they think Bill is suffering from auto-immune hepatitis. This condition is when the body attacks the liver.  It is usually triggered by an “event” they tell us. They said the event could have been taking Tylenol, drinking alcohol, or another means.

 

Molly and Colin Flynn came down to visit with the family this evening and it was a nice visit.  I just cannot believe how messed up Bill is. It is hard to believe someone his age can have so many things going wrong.

 

The main question is what the doctors are looking for as a sign of improvement and the answer is they have been hoping that his kidney functions would have improved by now.  We ask if there is still hope that he may improve and the doctor says that if there is no improvement by the end of the week, there would be no real chance of Bill surviving.  We agree to wait until the end of the week, but I don’t have much hope.  The weight of what is happening is incredible; it is hard to get much sleep at night.  I have a recurring dream when I do sleep, with Bill in it, and he is perfectly normal and everything is okay. Waking up brings the reality back to me.

 

14 Jan: It appears that Bill is more responsive today.  Though his eyes are closed, he seems to try and open his eyes and is moving his head and arms.  They were able to drain the excess fluid from his abdomen and at the same time x-ray his neck.  There was no damage to his neck, so the brace was removed.  This makes me feel better because it made him look much more comfortable. 

 

The ICU nurse says that he is beginning to breathe on his own, and the ventilator is doing less of the work.  Sook and Melissa come down to visit in the morning. The internal bleeding is also beginning to stop.  Don Larson comes by to visit Bill in the afternoon.  When Don speaks to Bill, he seems to try to respond – really affected by his presence. It is incredible how much better he is doing than he was in the morning.  By the evening the nurse restrains Bill’s hands because she is afraid he may try to pull out the ventilator tubes.

 

I leave the hospital for home that evening, need to get more clothes and meet with a lawyer to get a Will and Power of Attorney documents drafted.  The optimism is coming back, and everyone is feeling better.

 

15 Jan: At home in Alexandria I meet with my attorney and get the necessary documents for Bill to sign, if he can.  Walt and Kay Ulica came from Lake Anna to visit Bill.  I talk to Roger and learn that Bill is doing much better and they took out the ventilator tubes.  He is able to talk, but is very week and not making much sense when he talks anyway.  I look forward to seeing him on Friday, it seems like a miracle.

 

16 Jan: I took Bill’s SeaDoo down to the lake so we could get his truck into the garage at his house, so it will help with parking (a major issue in his neighborhood).  I speak to Walt and Kay about how their visit went, and it is great to hear from them the improvement in Bill’s condition.  I then leave for Richmond and go directly to the hospital.

 

At the hospital I see Andy Sand, Iggy Dauchot, Lila Edy, and Ross Fischer. They have all come from out of town to visit Bill.  I go into Bill’s room in the ICU with Ross.  Bill seemed to recognize both of us immediately.  Bill said something to Ross, but I could not understand what was said, but Ross just laughed.  Bill was very weak, but had his sense of humor.  He sometimes has trouble making sense when he talks, but moments later will seem quite lucid.  They brought his dinner into his room while we were visiting him, and he could not feed himself because his hands were shaking so much.  I fed him, and he opened his mouth just like Alex at the end of the movie “A Clockwork Orange”.

 

Ross had to catch a flight back to Atlanta that evening, but the rest of Bill’s friends were staying for the weekend.  It was hard to say goodbye to Ross, I had just met him, had heard so much about him from Bill over the years, and it was difficult to say goodbye in these circumstances.  Roger and I went out to dinner with Andy and Iggy that evening, and I think that was the first time all week I was able to laugh.

 

Jan 17: We all spent the day in the hospital with Bill.  He was moved out of the ICU and into a ward for kidney and liver patients.  He’s got a roommate and there is not enough room for all of us to be in the room at the same time, but it is less busy than the ICU.  Bill is doing better than the day before, he seems more lucid – he makes much more sense when he talks.  He is only hooked up to oxygen, no IVs.  He is still weak and his hands are still shaky.  Dad and Molly are visiting with him when I get there.  At one point they left the room to take a break and Bill looked at me and said “Well, Tom. I really f***ed up this time…”.  All I could say is that he needs to focus on getting better.  I did not know what else to say, and now wish that I could have said something that could have helped him.

 

We talked to a new doctor, Alan Rodgers, and he indicated that even though Bill was doing much better, he had a long way to go before even thinking about a new liver.  He also indicated to me that he would be in the hospital for a while, and indicated that he knew that Bill being in Richmond was a hardship on the family.  I told him that we just want him to get the best care and being with him in Richmond is not a problem.

 

Nancy’s friend Bonnie came into town today to visit Bill.  He has a big crowd here, but seems to have a lot of energy considering the shape he was in three days ago.

 

Jan 18: Dad and Molly came to the hospital in the morning and said goodbye to Bill.  They were heading back to Pinehurst to do laundry and get some rest before coming back up.  Andy, Iggy, and Lila were in the room when Dr. Rodgers came in and said that Bill could be discharged and go home today.  When he saw the shock in my eyes, he quickly asked if going home tomorrow would be better.  I said it would, so that we could figure out how to take care of him.

 

Bill’s condition continued to improve. He was eating and going to the bathroom on his own.  He needed some assistance to walk, but that was it.  Most of the day was spent visiting with Bill and watching football on TV.  Andy, Iggy, and Lila all flew back home in the afternoon.  Everyone was feeling very good about Bill’s condition and his chances for recovery.  It was a great feeling, like much of the weight was lifted.

 

The rest of us discussed what we should do with Bill tomorrow.  Bill wanted to be at his house, but we did not think that he could make it up the stairs to his bedroom.  If he had to stay in the rec room, he did not have a shower in that bathroom.  Unfortunately nobody else’s house had a better configuration, so it was agreed that Bill would go back to his house.

 

I went back to Alexandria that night, so that I could make up some hours at work.  Nancy, Ann, and Bonnie were going to bring Bill up the next day.

 

Jan 19: I went over to Bill’s house after work to see how he was doing.  He was on the couch watching TV and had the fireplace going full-blast.  He agreed that he would not be able to make it up the stairs, and seemed perfectly happy on the couch.  The hospital gave him a cane to assist him with walking and he seemed very comfortable with it.  Ann and Nancy had all the doctors’ instructions and the prescriptions, but their concern was they did not really give much direction on how to care for him, other than the prescriptions.  They planned to stay with Bill for the duration.  Bill is not eating a whole lot, but he just does not require much.  His water is rationed, due to the limited function of the kidneys, and he is not happy about that.  He suspects that Ann and Nancy are holding back some of his water rations…

 

Melissa and Joon came over to visit for a while.  Joon helped out by going to the drug store and buying Bill some Spree candy, which makes Bill very happy.  I think that helped him take his mind off of not being able to drink unlimited amounts of water.

 

Jan 21: I went to Bill’s house to visit after work.  He is in good spirits and shows me that he can get up and go to the bathroom without assistance, other than with his cane.  On his way back to the bathroom, he even does a little dance with his cane, pretending that he is Fred Astaire.

 

Bill hates taking one prescription, which he has to take 3 times a day.  It is to help clean his body out since the liver and kidneys are not doing their job.  The problem is he has to hurry to the bathroom soon after taking it.  It is a regular struggle for Ann and Nancy to get him to take the medicine, but he does so anyway.  He is being a good patient, and it is inspiring to see how well his disposition is, knowing how badly he must feel.  He is truly fighting for his life, and knows it, but seems to be doing his best to make everyone else feel at ease with the situation.

 

In talking to Ann and Nancy, they are getting concerned that they have such little information on what to do for Bill.  He is doing fine, but it does seem like there should be more we should be doing to help him get better.  I think we are all starting to wonder about the long-term chances Bill has.

 

Jan 23: I left work early to visit Bill today.  When I got there he had a physical therapist evaluating him.  She was surprised that she was the first healthcare person to see Bill all week.  She took his blood pressure and it was very low.  She also thought that the conditions of his legs and abdomen were not good and said that we should contact the doctor.  That afternoon Ann began to try to contact the doctor.  The therapist gave Bill some exercises to do and left.

 

The therapist also said that we should be monitoring his weight, but Bill did not have a scale.  I went out to get him a scale and other items: a shower stool for when we could get him up the stairs and a back/leg massager for when he is on the couch.  When I got back we set him up with the massager, and he loved it.  Unfortunately he did not get much time to enjoy it.

 

Late in the afternoon Bill’s doctor at Alexandria Hospital, Dr. Levinson, called back and talked to Ann.  She was told of the blood pressure readings and she asked Ann to bring Bill into the Emergency Room.  We were apprehensive about breaking the news to Bill, but he took it in stride.  He did not want to go back to the hospital, but he seemed to understand from what the therapist was telling him, that he needed some attention.

 

Ann and I got him to the hospital and they quickly admitted him, and began to hook him up to IVs and monitors.  I noticed at the hospital that he seemed to be kind of groggy and less lucid that he was in the middle of the day.  Dr. Asia, who treated him in the emergency room the last time he was there came by and did an initial examination.  Once all the paperwork was done and the emergency room evaluation complete Bill was moved back up into the ICU.  What started out okay, turned into a very bad day…

 

Jan 24: I went to the hospital first thing in the morning.  Bill was awake and seemed to be doing fine, better than the night before.  His blood pressure was still low, but was receiving medication to elevate it.  The main problem he had that morning was the need to go to the bathroom.  With all the wires and hoses connected to him, he could not get out of the bed.  The nurse helped him with the pressing need. The bigger problem is when they told him that he will need to be catheterized.  It was painfully obvious that Bill was not happy when he heard that news; he made it known in his own way – with humor.

 

The nurses told me that the blood tests came back and indicated that Bill had acetaminophen in his system, and asked how he would have access to Tylenol.  I knew for a fact that he had none in his house; since I had searched it the first time Bill went into the hospital.  When I talked to Ann she said that she did have some Tylenol PM in her backpack, but she never had her backpack open or took it out while she was there with him – it seemed hard to believe Bill would have taken it, especially since he was rarely alone.  They were giving Bill medicine to take the Tylenol out of his system, since if it stayed there it would further damage his liver.

 

Roger came by later in the morning and we hung out with Bill, watching ESPN Classic, which Bill said was making his hospital stay bearable.  That afternoon the channel showed the 1985 Purdue – Indiana basketball game, which seemed ironic.  The rest of the family came by that afternoon and we spent a lot of time with Bill.  He would often slip into a more groggy state, often speaking but not making much sense.  A little while later he would be normal again.  All this was due to the buildup of bad chemicals in his blood since the liver and kidneys were not working very well.

 

I went back to the hospital that evening to check in with Bill, for some reason I had a really bad feeling, and had to see Bill.  At that time Sook, Melissa, and Joon were there with him.  He seemed very tired, and when he tried to talk it was hard to understand him.  I did not stay long, but the rest of them stayed to keep him company.

 

Jan 25: Bill seemed about the same as the day before.  The doctors said they were planning to put him on dialysis to see if that would make him feel better. They also wanted to drain more fluid from his abdomen.  His blood pressure continued to improve.  They began giving Bill plasma to help maintain his blood pressure. He does not look like he is going anywhere soon.  He is in good spirits, and very cooperative with the nurses.  He hates the medicine for the acetaminophen, but chokes it down when they give it to him.  Bill had friends and family visiting him all day.  He is not eating very much, but the nurses do not seem concerned.  He is happy that he is able to drink as much water and juice as he wants, and still jokingly suspects that Ann and Nancy were holding back on his rations when he was at the house. Leave it to Bill to start conjuring up conspiracy theories about his water rations…

 

Jan 26: I leave work early to go to the hospital; I still have not been able to get the Will and POA documents signed because we have not had access to a Notary.  I am told that there is a Notary available at the hospital from 9 AM to 5 PM during the week.  When I get there Bill is asleep.  They took him into surgery that morning to insert the catheter for the dialysis machine, and they drained the fluid from his abdomen.  I hang out with Bill for a few hours, but he is in and out of consciousness.  Ann is also there for most of the day, but not much is going on.

 

Jan 27: I came over to the hospital after a meeting in DC that morning and Bill was very alert and in good spirits.  We got one of the nurses, who is a Notary, and Bill signed all the documents.  Later another nurse came by with a portable dialysis machine and hooked Bill up.  He was only on the machine for about 30 minutes that first day; they say more than that would be too much of a shock to the system.  The treatment will not only filter out his blood, but it will help to remove all the excess fluid that has been building up in his abdomen and his legs.

 

The dialysis nurse was very nice and encouraged us to ask questions about the treatment.  Bill and I were both fascinated by the machine and how it works. When describing the treatment the nurse told us the catheter that they installed goes from the jugular vein in his neck, all the way down into his heart.  We both cringed; we did not suspect that is how it worked.  When the nurse saw our reaction, she asked “too much information?” We both nodded our heads at the same time.

 

Bill seemed to feel pretty good and was much more lucid than yesterday, although the dialysis wore him out.  For me, knowing that they were doing something that would help him, the dialysis, lifted my spirits and gave me hope.

 

Jan 28: I got a call from Dr. Levinson as I was on my way home from work.  She wanted to talk to all of us about Bill’s condition and wanted to know when I could get there.  I hurried directly to the hospital. Nancy and Dan, Ann and Roger, and I were all there and Dr. Levinson told us that Bill’s condition is getting worse.  The bleeding is occurring again and his kidney and liver functions are shutting down.  She told us what the options are, but basically did not give us much hope and said we need to think about making him comfortable.  This is a big shock.

 

We visit Bill for a while and he is not very aware of what is going on and spends most of the time asleep.  Dad and Molly will be coming up tomorrow and we figure we can talk about it with them.  It is hard to believe that so much can change in one day.

 

Jan 29: I got to the hospital late in the afternoon and Dad and Molly were there.  They said he has been sleeping most of the time and is not responsive when he he looked. The main problem was he was bleeding so much.  He had so many holes in him from all the IVs, blood tests, etc. and he was bleeding out of all of them.  He was a mess.  The plasma they were giving him could not do the job to coagulate his blood.

 

We met with Dr. Kim that evening and he told us what we already knew.  Bill was getting worse, and would soon have to be hooked back up to all the life support in order to survive.  He told us that he really did not have a chance to make it long-term, and said that we could move him to hospice care in which he would be sedated and made comfortable.  In the ICU, Bill is constantly poked, prodded, and monitored which is not real comforting.

 

 Hospice care could be done at the hospital, at his home, or at an external hospice facility.  Dr. Kim said Bill would not survive more that a few days in hospice care.  We decided that it would be best to move him to hospice care in the hospital.  Dr. Kim told us he would be moved some time on Friday.  We all are having a hard time dealing with this decision, we have been faced with it before but with Bill doing so well last week it does not seem fair.

 

Jan 30: I went to the hospital in the morning and met up with Dad and Molly.  Bill’s condition obviously had not changed, he was unconscious. We were waiting for him to be moved out of ICU and into a regular room.  Doug Watts stopped by and we told him what was going on.

 

Bill was moved early that evening.  We were told he would be in a private room if they had one available, and when we got there he had a roommate, which was a disappointment.  Bill looked peaceful and he was being taken care of.  We said goodbye to him and then we went and had a nice dinner at a restaurant nearby the hospital.  Seeing Bill in the new room without any machines or monitors connected to him made it sink in that he was not going to get better, but it did make him look more comfortable.  We thought we would have him at least for a couple more days.

 

Jan 31: I went to the hospital that afternoon.  I was just entering the parking lot at 1 PM when I got a call from Roger, and he told me that Bill had just passed away.  I told Roger I would be right there.  I called Dad and Molly, since they had come to the hospital that morning to say goodbye to Bill before driving back to Pinehurst.  I told them the news.  I then went up to Bill’s room, when I got there Roger was there and Melissa and Joon were there too.

 

During the next 30 minutes or so there were several friends and family members who came in to say goodbye to Bill.  They all had planned to come and visit, not thinking Bill would already be gone.  I think all of us thought we would have Bill for a couple more days. I just wish we had told him he would have so many visitors.

 

Later that afternoon, after making arrangements for Bill, we decided to go to the hospital cafeteria and get something to eat.  Ann was on her way to the hospital so we would wait for her there.  Don Larson ate with us.  When we were finished, we all had a strong feeling that we needed to get out of that hospital.  Dan and Nancy were on their way over from Chantilly so we told them to meet us over at Bill’s house.  There we stayed for a while, trying to get used to the thought that Bill was no longer with us, and realizing we will have to go on without him.