After a Grim Diagnosis, Determined to Make a ‘Good Ending’

From: http://www.nytimes.com/

By MARK LEIBOVICH

Published: August 26, 2009
WASHINGTON — The once-indefatigable Ted Kennedy was in a wheelchair at the end, struggling to speak and sapped of his energy. But from the time his brain cancer was diagnosed 15 months ago, he spoke of having a “good ending for myself,” in whatever time he had left, and by every account, he did.

Mr. Kennedy at Fenway Park in Boston before delivering the ceremonial first pitch on opening day for the Red Sox this April, driven by the former Red Sox great Jim Rice. More Photos >
As recently as a few days ago, Mr. Kennedy was still digging into big bowls of mocha chip and butter crunch ice creams, all smushed together (as he liked it). He and his wife, Vicki, had been watching every James Bond movie and episode of “24” on DVD.

He began each morning with a sacred rite of reading his newspapers, drinking coffee and scratching the bellies of his beloved Portuguese water dogs, Sunny and Splash, on the front porch of his Cape Cod house overlooking Nantucket Sound.

If he was feeling up to it, he would end his evenings with family dinner parties around the same mahogany table where he used to eat lobster with his brothers.

He took phone calls from President Obama, house calls from his priest and — just a few weeks ago — crooned after-dinner duets of “You Are My Sunshine” (with his son Patrick) and “Just a Closer Walk with Thee” (with Vicki).
“There were a lot of joyous moments at the end,” said Dr. Lawrence C. Horowitz, Mr. Kennedy’s former Senate chief of staff, who oversaw his medical care. “There was a lot of frankness, a lot of hugging, a lot of emotion.”

Obviously, Dr. Horowitz added, there were difficult times. By this spring, according to friends, it was clear that the tumor had not been contained; new treatments proved ineffective and Mr. Kennedy’s comfort became the priority.

But interviews with close friends and family members yield a portrait of a man who in his final months was at peace with the end of his life and grateful for the chance to savor the salty air and the company of loved ones.

Befitting the epic life he led, Mr. Kennedy was the protagonist of a storybook finale from the time of his diagnosis in May 2008. It was infused with a beat-the-clock element: his illness coincided with the debate over health care (“the cause of my life”) and the election of a young president he championed.

Mr. Kennedy raced to complete his legislative work and his memoirs (“I’ve got to get this right for history,” he kept saying), leaned heavily on his faith, enjoyed (or endured) a procession of tributes and testimonials and just recently petitioned Gov. Deval Patrick of Massachusetts to push for a speedy succession so his Senate seat would not be vacant long.
The knowledge that his death was approaching infused Mr. Kennedy’s interactions with special intensity, his friends say.

“He was the only one of the Kennedy boys who had a semi-knowledge that his end was near,” said Mike Barnicle, the former Boston Globe columnist and an old friend who lives nearby on Cape Cod and visited the senator this summer. “There was no gunman in the shadows, just an M.R.I. It was a bad diagnosis, but it allowed for the gift of reflection and some good times.”
Even as Mr. Kennedy’s physical condition worsened over the summer, he still got out of bed every day until Tuesday, when he died in the evening, said Senator Christopher J. Dodd, Democrat of Connecticut and one of Mr. Kennedy’s closest friends in the Senate.
“I’m still here,” Mr. Kennedy would call colleagues out of the blue to say, as if to refute suggestions to the contrary. “Every day is a gift,” was his mantra to begin conversations, said Peter Meade, a friend who met Mr. Kennedy as a 14-year-old volunteer on Mr. Kennedy’s first Senate campaign.

Some patients given a fatal diagnosis succumb to bitterness and self-pity; others try to cram in everything they have always wanted to do (sky-diving, a trip to China). Mr. Kennedy wanted to project vigor and a determination to keep on going. He chose what he called “prudently aggressive” treatments.

“He always admired people who took risks, like Teddy and Kara did,” Mr. Dodd said, referring to two of Mr. Kennedy’s children, who both beat cancer with bold treatments. And he vowed to work as hard as he could to lead a legislative overhaul of the nation’s health care system.
“He was the irrepressible Ted Kennedy,” said Senator John Kerry, the Massachusetts Democrat, who visited with his longtime colleague last week. “He was determined to get things done, but he also understood he had limitations.”

Mr. Kennedy deputized Dr. Horowitz, who lives in the San Francisco Bay Area, to research all treatment options before deciding on an intensive regimen of surgery, chemotherapy and radiation — hardly a clear-cut choice with an almost inevitably lethal disease and a patient of Mr. Kennedy’s age. Some physicians assembled at Massachusetts General Hospital considered his tumor inoperable — and measured his likely survival time between six weeks and a few months.

Before he traveled by private plane from Cape Cod to Duke University Medical Center for his surgery in June 2008, Mr. Kennedy made sure to put his affairs in order — his will, his medical directives and even his legislative instructions, family members say.

On the way to the airport, he called two Democratic colleagues: Mr. Dodd, telling him to take over a mental health bill he had been working on, and Senator Barbara Mikulski of Maryland, instructing her to take over a higher education bill he had been shepherding.

“Barbara,” he boomed over the phone, “as if he was at a Red Sox-Orioles baseball game,” Ms. Mikulski said in an interview. Just days after the surgery, Mr. Kennedy began following up with Ms. Mikulski. “He was Coach Ted,” she said.
Mr. Kennedy took no comfort, friends say, in hearing how missed he was in Washington, or how in his absence he had been become something of a “spiritual leader” on issues with which he is identified, like health care. He kept in close touch with his staff and colleagues, and he was engaged in a running conversation with Senator Harry Reid of Nevada, the majority leader, on the delicate subject of whether Mr. Kennedy would be available to vote.

Mr. Reid assured him that he would not ever ask him to come to Washington unless his vote was essential. (His disease and treatments made Mr. Kennedy vulnerable to infections, so wading into crowded areas was risky.) When a crucial Medicare provision came up last summer, Mr. Reid asked Mr. Kennedy if he could make it down.

Mr. Kennedy’s family and staff debated the issue until the senator ended it. “I’ll be there,” he said, according to a member of his staff who was involved in the decision. He received a standing ovation when he returned to the Senate floor, and the bill passed easily.
Vicki Kennedy fiercely guarded her husband’s privacy, but Mr. Kennedy’s illness had an undeniably public component. His setbacks and hospital visits often drew news media attention. After his emotional speech at last summer’s Democratic Convention in Denver, it was disclosed that he had been suffering from kidney stones and had barely been able to get out of his hospital bed a few hours earlier.

He had to memorize the text of his speech because he struggled to see the teleprompter (his surgery had left him with impaired vision). The seizure Mr. Kennedy had at an Inaugural luncheon at the Capitol led his son Patrick to joke that his father was trying to overshadow Mr. Obama on his big day.

Mr. Kerry remembers Mr. Kennedy telling him on the Senate floor in March that he was having trouble preparing for an event he had been extremely excited for — throwing out the first pitch on opening day at Fenway Park.

While Mr. Kennedy typically told people he felt well and vigorous, by spring it was becoming clear that his disease was advancing to where he could not spend his remaining months as he had hoped, helping push a health care plan through the Senate.

He left Washington in May, after nearly a half-century in the capital, and decamped to Cape Cod, where he would contribute what he could to the health care debate via phone and C-Span. He would sail as much as possible, with as little pain and discomfort as his caretakers could manage.
He also told friends that he wanted to take stock of his life and enjoy the gift of his remaining days with the people he loved most.
“I’ve had a wonderful life,” he said repeatedly, friends recalled.
Mr. Dodd, in an interview, said: “At no point was he ever maudlin, ever ‘woe is me.’ I’m confident he had his moments — he wouldn’t be Irish if he didn’t — but in my presence, he always sounded more worried about me than he was about himself.”
Starting in late July, Vicki Kennedy organized near-nightly dinner parties and singalongs at the Kennedy compound in Hyannis Port. The senator was surrounded in the dining room by his crystal sailing trophies and a semiregular cast of family members that included his three children, two stepchildren and four grandchildren. Jean Kennedy Smith, Mr. Kennedy’s sister, had rented a home down the street this summer and became a regular, too. Instead of singing, she would sometimes recite poetry.

Even as Mr. Kennedy became frustrated about his limitations, friends say his spirit never flagged. “This is someone who had a fierce determination to live, but who was not afraid to die,” said Representative Bill Delahunt, a Democrat and a Kennedy friend whose district includes Cape Cod. “And he was not afraid to have a lot of laughs until he got there.”

In recent years, friends say, Mr. Kennedy had come to lean heavily on his Roman Catholic faith. In eulogizing his mother, Rose Kennedy, in 1995, he spoke of the comfort of religious beliefs. “She sustained us in the saddest times by her faith in God, which was the greatest gift she gave us,” Mr. Kennedy said, his voice stammering.

He attended Mass every day in the year after his mother’s death and continued to attend regularly, often a few times a week.

The Rev. Mark Hession, the priest at the Kennedys’ parish on the Cape, made regular visits to the Kennedy home this summer and held a private family Mass in the living room every Sunday. Even in his final days, Mr. Kennedy led the family in prayer after the death of his sister Eunice on Aug. 11. He died comfortably and in no apparent pain, friends and staff members said.

His children had expected him to hold on longer — Mr. Kennedy’s son Patrick and daughter Kara could not get back to Hyannis Port in time from California and Washington.

But the senator’s condition took a turn Tuesday night and a priest — the Rev. Patrick Tarrant of Our Lady of Victory Church in Centerville, Mass. — was called to his bedside. Mr. Kennedy spent his last hours in prayer, Father Tarrant told a Boston television station, WCVB-TV.
Mr. Kennedy had told friends recently that he was looking forward to a “reunion” with his seven departed siblings, particularly his brothers, whose lives had been cut short.
“When he gets there, he can say ‘I did it, I carried the torch,’ ” Mr. Delahunt said. “ ‘I carried it all the way.’ ”

Blogger comment:
Senator Ted Kennedy was inspirational to us in his life, in dying and after death. He died with grace enjoying his last days with the best in his life his family, friends and his memories. He died in peace with the world and with his God. He died with grace making people around him happy during his dying, a real gentleman to the last hour.