Audrey Ghizzoni had a bad night two Sundays ago. Some friends had come for dinner, "but I think they could tell I wasn't feeling so well." The friends left about 9 p.m., much earlier than usual, and Audrey retired to the yellow first-floor bedroom of her North Arlington home, where she has spent nearly all her time since February. She felt "rotten, as rotten as I've ever felt."
Three hours later, Audrey was extremely short of breath and had begun to worry that her ulcer was about to start bleeding, which could have plunged her into a coma. So she called the Hospice of Northern Virginia and did something she had never done before.
She asked to be admitted.
Audrey has been under the medical supervision of HNV since April, but she has never had to spend the night at HNV's facility on North 15th Street in Arlington. HNV encourages patients to stay at home whenever possible and for as long as possible. Until her late-night episode, Audrey had been able to manage in the house where she has lived for 15 years, with the help of her husband John and their 25-year-old son Jack.
But the phone call two Sundays ago was Audrey's first admission -- to herself and to her family -- that she was beginning to be so overrun with illness that home might no longer be the best place for her.
As it turned out, there was no need for any siren-blaring scramble by ambulance. A doctor prescribed special medication by phone. Luckily, the Ghizzonis had some in the refrigerator, left over from a previous episode. Audrey's shortness of breath abated and her ulcer never bled. She even managed to get a couple of hours of sleep. She had dodged another emergency.
But Audrey Ghizzoni cannot expect to dodge them much longer. At 61, this lawyer and social activist is terminally ill with emphysema. She has a few months to live, perhaps less. At my request, she has allowed me to visit her regularly throughout the final portion of her life, in the hope that other dying people and their families might learn from her situation.
What Audrey has learned from her "rotten, rotten night" is that she became so focused on the present that she didn't consider the future.
"I never thought it might be my last trip," said Audrey, "All I knew was that I felt so-o-o-o terrible, and I wanted to feel better. And I thought, 'I've had enough of hospitals.' I was worried that I might go into a coma and have to go back into the hospital. It's kind of funny, but it struck me that every time I've gone into the hospital over the last few years she has had several extended stays , someone has been over to dinner the night before."
Because she was in such bad shape two Sundays ago, Audrey's husband and son shared an "all-nighter" at her bedside. In many ways, that was harder on Audrey than her illness.
"There was no panic," she said. "They were both very calm. They've been through it so much. But I am so conscious of being a burden. Sometimes, I'm very demanding of them. They'll just be getting settled after getting me something, and then I'll need something else."
So she's feeling guilty?
"More than ever, because I have to have more done for me. I'm really starting to notice that. I don't have the stamina I had a month ago."
Yet she has the wit. I asked about the counseling sessions she has been having with her husband and an HNV social worker. "Well, after 36 years of marriage, a lot of things come out," she said, with a wide smile. "Like maybe his mother didn't like me so much, and maybe mine didn't like him so much." And when nurse Amy Krywancz tells of a patient who threatened to wash down his pills with vodka, Audrey wonders if generous helpings of that beverage might be the answer -- not to some of what ails her, but to all of what ails her.
Still, beneath the jokes and the grins, this is a woman who knows how sick she is, and how gravely the risks have begun to multiply.
The doctor has just reduced Audrey's dosage of a drug called prednisone. To a healthy person, that would probably be a sign of improvement. But to Audrey, it merely means that one problem is being exchanged for another.
Reducing her prednisone dosage may increase her blood sugar level. That in turn might touch off extremely serious side effects, since Audrey has contracted diabetes during her extended bout with emphysema. Meanwhile, the threat of suddenly being unable to breathe hovers over Audrey constantly.
"But I really do believe what I've said," Audrey declares. "I'm not putting up a front . . . . What I've learned is that you can't be afraid to think about it death . This whole process has to be up to the person who's sick. I have to control it mentally, or it would be much tougher . . . .
"I don't think about being dead. I think about having people around me. If I sit here and cry, nobody will want to see me, whereas if I am pleasant, people will come. The day goes by much faster when people are in and out."