A GRACEFUL PASSAGE
A GRACEFUL PASSAGE
As I sat down next to Klaus’ bed, we grasped hands. I rested the back of my right hand alongside his pillow as he slid his left hand on top of mine, tightening, then loosening his grip. His hands were cool and dry. I felt his life force and he felt mine in a kind of energy exchanging dance. We remained this way for the next five hours, even when the nurse came to give him his morphine.
From time to time, I’ll meet someone who asks me about my work with people diagnosed with cancer and at end-of-life.
They ask, “Isn’t it depressing?”
My answer is always "no."
I don’t think I could do this work if it were depressing. It can be sad and emotional in other ways and sometimes includes more laughter than most people can imagine. For me it is compelling and it is work which I think my Cancer Connect Chiang Mai partners and I are temperamentally suited. For us, it’s a calling.
This work began for me in 2009 after I was diagnosed with muscle-invasive bladder cancer. During the time I was making decisions about diagnostic procedures and treatment options, Elise, whom I knew socially, called and offered to visit and share some of what she learned while being treated for colon cancer. Even though I didn’t feel like talking about my condition with most people, there was something in her soft British accent and the tone of her voice that caused me to say yes.
Although she told me some details of when she was diagnosed and treated for colon cancer, what I remember most about that visit was her telling me that she was wearing a colostomy bag. She was dressed in a skirt and blouse with a wide piece of fabric around her waist. I couldn’t detect a bulge nor did Elise seem to have any inhibitions about her appearance. So, I was surprised and said, “Really?”
Elise just said, “Yes, I do.”
This experience was quite significant for me because one of the decisions I was facing was what kind of artificial bladder would be best for me after my cancer infected bladder was surgically removed. I knew I’d have to have a bag either inside or outside my body to hold the urine draining from my kidneys between trips to a bathroom. I didn’t like the idea of an external bag, but at that time there wasn’t a urologist in Thailand who had performed enough internal bladder procedures for me to feel confident to have that procedure done here.
All of a sudden, just listening to Elise and observing how comfortable she appeared to be in her body, I said to myself, “I can do that.”
That was the moment I decided I could deal with wearing a urostomy bag and it was also the moment that the seed of Cancer Connect Chiang Mai (CCCM) was planted. Six months later, Elise and I co-founded CCCM to provide support for others in Chiang Mai who are diagnosed with cancer.
It wasn’t long after we started CCCM that we assisted a man with advanced prostate cancer who didn’t survive. It was our first end-of-life case and caused us to realize we could also support those people who would not survive their cancer. Anne, the young Thai widow of the man who had just died, leaving her as a single mother of a 5-year-old son, told us she wanted to assist other women like herself. Anne had learned a lot about home health care and the Thai medical system during the months she was her husband’s caregiver. She also had excellent relationship skills and was bilingual, so she added immediate value to our team.
It’s been ten years now and CCCM is still Elise, Anne, me, and we’ve been blessed with a small number of cancer survivors, who assist us as needed. We’ve also been blessed with Kate, a British Palliative Care Nurse, who joined our team while she lived in Chiang Mai for several years and still assists us from the UK, where she now resides and works in hospice care.
Except for Kate, none of us had a medical background. Elise is a speech therapist, I am a retired business consultant, and Anne has a degree in mass communications. What we all have in common is an ability to step into the kinds of emotional crises in which people find themselves when they or their loved one is faced with cancer or at end-of-life. Elise, Anne, and I all completed the Clinical Pastoral Education (CPE) course at Chiang Mai University. We’ve read many books about cancer, caregiving, and dying, we’ve developed a database of local oncologists and specialists, and we have several excellent online sources of information about the kinds of conditions we encounter. But we’ve learned most from the people and their families we’ve assisted.
Sometimes due to their illness, the people we are assisting are unable to communicate with loved ones in their home countries. We also facilitate those communications and form intimate relationships which often become long-term friendships.
Klaus’ daughter, Heidi is one of these long-term friendships. A lovely 35-year-old German/Thai woman, she started her own company designing and manufacturing fashionable bras for large-busted women during the year her father died. Last year Heidi sent me an email telling me she would be visiting Chiang Mai to spend some time with her mother and asked me to meet with her at a local tea shop where we spent two hours reminiscing about the last months of her father’s life.
A few weeks ago, I received another email from Heidi, asking if we could meet again. As we greeted each other this time, I felt like Heidi was like an old and dear friend which I realized is what we had become. Much like other people whose relationships were forged during a crisis, we have a special bond and intimacy, and like the previous year, we talked non-stop for two hours. This time we spoke more about what was going on in our own lives. Heidi told me, “I’m taking a year off from my company to take a course to become a Death Doula (a person who assists people at end of life).”
I was surprised Heidi would put her business on hold to pursue an entirely different career, but in another way, I wasn’t surprised at all. I remembered our first meeting four years before in February of 2016. Heidi had been referred to Cancer Connect Chiang Mai after her father had been diagnosed with cancer. I spoke with Heidi on the phone and agreed to meet her and her father at Suan Dok, the main public hospital in Chiang Mai. Heidi told me her father was a 71-year-old German man, who had lived in Thailand for many years. He had been married to her mother Unchai, a Thai woman, for 40 years. Heidi lived in Germany and spoke excellent Thai and English.
The following day I met Heidi, Unchai, and Evelyn, Klaus’ sister who had just arrived from Germany, at the foot of Klaus’ bed in the men’s cancer ward at Suan Dok Hospital. The men’s ward has six beds on each side of the room and when I arrived there were four or five other patients who had visitors at their bedsides. Heidi and Evelyn introduced themselves. Unchai stood behind them hesitating, which I sensed was because she wasn’t confident speaking English. I shook hands with Heidi and Evelyn, then put my hands together and gave Unchai a Thai Wai greeting.
No one wanted to be in this room. Some of the men in the beds were wincing in pain, loved ones trying to comfort them, some people were weeping and with so many people talking, the noise level was almost overwhelming. I moved to the side of the bed and extended my hand to Klaus as I moved my head closer to his. “How are you feeling right now?” I asked. He responded softly, “I’m ok,” and with his free hand pointed at his throat, and with great effort, he said, “sore.”
Heidi’s memory: I remember you coming into the hospital room at Suan Dok that dad shared with so many other patients. And, that you had no qualms about reaching for his hand and really looking at him. That gesture, even though you didn’t know him at all, touched me deeply because touching is not something we did very much in our family and you did it so naturally, even with a stranger! My dad needed that kind of contact at that point.
As we were getting acquainted, a group of six or eight young men and women in white coats entered the ward and stopped at the end of Klaus’ bed. Heidi whispered to me, “The woman speaking in Thai to the others is Dr. S, the doctor who admitted Klaus to the hospital.”
The young men and women in white coats who stood around her were residents. It was just my good fortune to be there when Dr. S, a GI specialist, was making her rounds. She spoke good English, and she was willing to answer questions.
Dr. S told us, “Klaus has a tumor in the upper part of his stomach extending into the esophagus. My treatment plan is for Klaus to get strong enough to begin chemotherapy to shrink the tumor. This is a pre-operation procedure so the tumor can be surgically removed. He is also healing from a wound he suffered when the gastric feeding tube was inserted.”
Dr. S estimated it would take about a week for the wound to heal and maybe then he could go home and begin chemo as an outpatient. The chemo plan was for at least four rounds, one per week; then he’d receive a CT Scan and probably four more rounds before the tumor was reduced sufficiently for surgery.
After Dr. S and the interns left, Heidi asked me if I could help Klaus with an Advanced Directive (aka a Living Will). I agreed to bring one to the hospital on Saturday, and help Klaus to fill it out. When I got home, I sent an email to Kate, the medical expert of our team, asking her opinion about Dr S’s diagnosis and treatment plan, based on what I had heard so far.
Kate was away for the weekend, but quickly responded, Do we know if the cancer has been staged? Are lymph nodes involved? Is he able to swallow at all? It concerns me that they can't pass a feeding tube.
Because I didn’t have the answers to any of these questions, I immediately emailed Kate’s questions to Heidi to ask Dr. S. Kate also wrote the following, which was an esophageal cancer tutorial for me:
Treatment with chemo to reduce the tumor size would be the first-line treatment, even if just to help with his symptoms and allow him to swallow. Whether he will be able to go ahead with the surgery will depend on his response to the chemo, how far the tumor has extended into other structures, and whether it can be surgically removed.
When I met with Klaus and the family on Saturday, Heidi had met with Dr. S and told me the answers to Kate’s questions: “The CT scan showed the cancer originated in the stomach, metastasized to the esophagus and it was stage 4; there didn’t appear to be lymph node involvement; Klaus’ difficulty swallowing was due to the tumor pressing against the esophagus.”
Heidi also told me she had managed to obtain a private room for Klaus to be moved to the next day. Then I explained the purposes of the Advanced Directive and guided Klaus in filling it out.
The following morning Heidi called to tell me that Klaus had a new feeding tube and a vascular port for chemo, his IV medications installed, and a pain management specialist had adjusted his pain medication. As Heidi was telling me this, I recalled my hospitalization, and the helplessness, discomfort, and loss of dignity that goes with being treated for cancer, and felt a wave of empathy for Klaus.
I agreed to come back a few days later with Elise and Anne. Evelyn was returning to Germany the following week and Heidi would be leaving at the end of the month. They both wanted to meet the rest of our team who would be assisting Klaus in their absence. Elise, Ann, and I all arrived at Klaus’s new private room together. There are only a small number of private rooms at Suan Dok, because it is a public hospital, and most Thai people cannot afford a private room. Klaus’ room had three beds, but mercifully, he was the only patient in the room.
Heidi, Unchai, and Evelyn were all there to greet us. Unchai, exhausted, had stayed there the night before as hospitals in Thailand prefer that a family member stays in the patient’s room. After introductions, Anne sat on the bed with Unchai, at the furthest end of the room from Klaus. Unchai was relieved to speak to someone in her native language and they began to chatter away in Thai. Elise and Evelyn sat on the middle bed and they quickly bonded. I stood alongside Klaus’s bed. He could barely talk, so I carried our conversation slowly while doing a lot of hand squeezing and lip-reading.
I had made a good connection with the family during my previous visits when a lot of information was exchanged. This visit with three different conversations going on at the same time was more like a reunion. Anne has a natural way of being that makes it easy for Thai wives to talk and vent their pent-up feelings, especially their hurts and fears. Unchai trusted Anne immediately and was soon sharing very personal stories of her marriage and other struggles, the kind of things she hadn’t been able to say to Klaus.
Elise was the first person, outside the family, with whom Evelyn was able to have a meaningful conversation about what she was thinking and feeling about her just diagnosed brother, as well as the pressure cooker she walked into almost immediately after arriving from Germany. Elise has a calm presence and people feel safe with her. I remember looking across the room at both of these conversations, watching shoulders and facial muscles relaxing, hearing soft sounds of animated conversation with words I couldn’t quite hear.
Unchai told Anne she was afraid of being left alone with Klaus after he returned home. She was recovering from knee surgery the previous year and was intimidated by the idea of being responsible for changing his feeding bag and assisting him to go to the toilet. Anne told Unchai these fears were not unusual and she convinced Unchai she could find a caregiver to come to their home and help as needed. Elise assured Evelyn that she and Heidi could be in direct contact with her and me by email and Skype while they were in Germany.
As if it weren’t enough for patients and their families to gain an understanding of the diagnosis and treatment options, there are almost always financial concerns that must be addressed and it’s always a delicate subject. Thailand is known for its excellent and affordable medical care, but as in most of the world, knowledge of local practices is crucial. One example in Chiang Mai is that public hospitals often charge a premium cost for Westerners.
The room cost at Suan Dok was the catalyst for Kate to suggest moving Klaus to Sriphat, a private hospital in an adjoining building, where the private room would be about the same cost as the premium cost private room at Suan Dok. Kate pointed out that while doctor's fees and surgery would cost more, there would be less uncertainty in the length of time Klaus would have to wait for procedures, and more importantly, Sriphat had a palliative care team who work within the hospital and can prescribe pain medicines.
Due to restrictions on morphine within Thailand, injections are not an option at home. But Dr. PK, the pain management specialist at Sriphat, could prescribe the use of a Fentanyl patch as an alternative to use with liquid morphine as needed and could be administered through a feeding tube.
Another option for palliative care in Chiang Mai is McKean, a rehabilitation hospital authorized to administer morphine injections as needed. We’ve had several patients choose McKean for their end-of-life care and have been impressed with the level of compassionate care they offer. Since Klaus and Unchai’s home is located near McKean, the decision was made to move Klaus there for a week while evaluating his treatment options.
Klaus was aware that my wife Keiko and I were about to leave for a meditation retreat and he wanted to have a conversation with me about his options before I departed. When I arrived at his room Heidi was the only person with him and she moved to the bed at the far end of the room checking her emails while he and I sat in silence together until he indicated he was ready to talk.
He asked, “What will happen if I don’t want chemo or surgery?”
I told him he could choose to have palliative care. He didn’t respond immediately and appeared to be thinking. I realized he might not have understood what palliative care meant. I wanted him to understand clearly that choosing palliative care is a monumental decision for any of us because it is the ultimate confrontation with our mortality.
I explained, “Palliative care is essentially a change in priorities from the quantity of life, which means doing everything possible to extend your life, to quality of life, which means stopping treatment and doing everything possible to be comfortable, pain-free, maintain your dignity and enjoy every moment you are given.” I asked if he understood and he said, “Yes.”
I went on, “Most people resist palliative care until they are near the end of their lives because it means accepting your imminent death.”
Klaus didn’t reply immediately, but after a long pause, he said, “I’m pretty sure I don’t want chemo.” Hearing him say these words, Heidi walked over to the opposite sides of his bed from where I was standing. I looked over at her and just as the thought came to me, I suggested she use her phone to video this conversation. She still has that recording.
This is Heidi’s transcript of a portion of the recording:
Klaus: There’s nothing much I need to complete. No sort of grand works in a drawer that I need to complete. There are quite a lot of odds and ends, which are left to my dear Heidi. What's left for me to do is just odds and ends, if they get them done fine, if they don't get them done, that's all right. So...I just want to live out my days, enjoy the people around me, having some good food — passing the natural channels, if at all possible…. Uhmmm...and then, just say, 'death come take me'. And there are so many others that I know that have already died. So if they could do it, why not me?
The one thing I'm afraid of now is to be stuck, you know, stuck on a bed handled by nurses on orders by doctors that hardly look at you.
As you know, when suffering a considerable pain...uhm...without finding refuge. That’s when the long years of practice come in, which I haven’t done. What I regret most is not having done enough practice. (For Klaus, a practice meant his meditation practice).
Carl: Sounds like you have done enough to make the kinds of decisions you’re making today right here and now.
Heidi: I think so too.
When I asked Heidi what she remembers of that conversation, she said, “What I remember most vividly is feeling like there were things I really wanted to tell my dad before he died; how he gave me a wonderful and happy childhood, how much I admired him for all that he had done and achieved in his life, and that I love him and I was going to miss him.”
She wiped a trace of tears from her eyes, took a deep breath, and continued, “I didn't have an emotional support network in Chiang Mai. Neither my mom nor my aunt was the kind of person I could fall apart with. But you being there, holding that space made a difference. It seemed to take a natural flow that enabled me and my dad to open up and risk losing our shit with each other.”
Those were my last conversations with Klaus and Heidi before I left for India. It was difficult to leave Klaus at this critical point, but I had learned I wouldn’t last long doing this kind of work if I didn’t learn to let go and give myself the care I needed. Thankfully, I was part of an excellent team I knew I could trust to do the right things in my absence. It was still hard to leave.
The next day Klaus was moved to McKean Hospital. Heidi, Unchai, and Evelyn were there to celebrate his 72nd birthday with him. A week later the family decided to transfer Klaus to Sriphat where Dr. C, the head of oncology, took charge of his treatment. Dr. C examined Klaus and gave Heidi a range of options to consider: have the surgery first, to be followed with chemo later, which he recommended if Klaus wanted short term improvement; have chemo first to be followed with the surgery, which was better for longer-term survival; and a third option because Heidi was worried that Klaus couldn’t tolerate chemo in his condition, installing a stent to open Klaus’ esophagus which was a minimally invasive procedure, and after Klaus was able to eat orally for a few weeks, then begin the chemo.
Evelyn was influenced by her memory of how strongly Dr. S had argued (while Klaus was at Suan Dok) for chemo as fast as possible. Since Evelyn was about to return to Germany, Klaus agreed to have a round of chemo, before she departed. He didn’t like the side effects, especially nausea and how weak and listless he felt for several days following the chemo and never felt chemo was right for him.
A month later, he emailed his friends that he was still ambivalent:
As promised, herewith an update on my state of health. I have been in hospital from the beginning of February. Today Is my last day at the Sriphat hospital and I am looking forward to spending the Songkran holidays at home. What will happen afterward has not been decided yet.
Klaus returned home on April 9 and during the next two months, Elise and Kate were both in frequent contact with Klaus and the family. Anne continued her regular visits with Unchai in her multiple roles of friend, therapist, and guide. Heidi, Evelyn, and Unchai all settled into a routine in which they could care for Klaus and themselves while he was at home.
Pain management would continue to be critical for Klaus. From then on, with Kate’s guidance and Dr. PKs pain management, Klaus was finally able to get relief with the combination of stronger and stronger fentanyl patches combined with liquid morphine injected through his feeding tube at regular daily intervals. Klaus was also practicing meditation to calm himself, which helped him to manage the increasing levels of pain.
Meanwhile, Keiko and I had just completed the second month of our retreat. I thought often of Klaus, and Elise kept me in the loop via email. But, the truth is I couldn’t have been further from Klaus and his struggles. Everything at Bodhi Zendo (BZ), the Zen meditation center where we were staying, is designed to keep guests focusing inward. BZ is located in the mountains of Tamil Nadu in South India, surrounded by trees, with manicured grounds and plants, an organic garden, a Zen garden, and a lovely pond. Our days were spent within and around this peaceful oasis in meditation and contemplation, listening to spiritual talks, reading, and visiting with longtime friends we meet there every year. Instead of suffering, we were in a place of tranquility, renewal, and inspiration.
I sent Klaus emails a few times a month and at the beginning of May he sent me this email:
Thank you for thinking about me and for the gentle nudge to communicate.
Being taken care of in the familiar surroundings at home, for me at least, is essential for having a good quality of life. Another ingredient is the often mentioned ‘positive attitude’. No longer imprisoned on a hospital gurney, I have regained some strengths and am more mobile, although I still tire quickly.
I also had much time to ruminate about the future, to read cancer blogs, and generally feel sorry for myself. I realized that I had chosen ‘palliative care’ as my treatment option. This implies a prospective survival time in months rather than years, hopefully, happy ones, and free of pain before ending with death. Maintaining equanimity while facing death is frequently on my mind. Without it how do you keep a positive attitude?
Should I let my fear of death influence my choice of treatment? Should I let the fear of side-effects dictate my treatment options? It will always boil down to our values. Carl, I am sure you could help me with my struggle. I still have my ups and downs.
With equal loving kindness.
Keiko and I returned to Chiang Mai in late May. I was eager to reconnect with Klaus after being away for almost three months. During my last few weeks I remember people looking at me quizzically when I told them I was looking forward to being back home so I could be with a dying man.
I remember sitting with Klaus for the first time in his own home surrounded by the lush trees he planted when the house was built and nurtured to provide the beauty and shade that he so enjoyed. I felt a strength in his presence I hadn’t felt before — calmness during his unremitting decline.
He told me he was at peace with his decision to choose palliative care and that he was happy to be home with his family. During this conversation and the many that followed, I grew to understand more about Klaus and how he was able to maintain his equanimity under such difficult circumstances. He loved living the life he was able to live, and he was grateful for the support of his family and our CCCM team.
He said there was something in him that drew him to live in a Buddhist country. He learned to speak the Thai language fluently and he loved the people, the culture, the food and he loved to sit in wats (Buddhist temples) and listen to the monks chanting. He enjoyed the tranquility he found there. Buddhism gave him something to believe in and it was a belief he continued to strengthen during the last months of his life.
Klaus had an intense love of nature and pronounced dissatisfaction with city life. The purpose of his work was nature conservation and designing and implementing programs to educate people about the environment. I asked Heidi what she remembered about her dad’s love of nature. She told me that when she was growing up, they spent vacations visiting national parks in Thailand, Laos, and Malaysia:
"He would tell me about different things along the trail: animal footprints and which animal they belonged to, dung, and how the freshness could tell you how recently the animal had been there, and of course, he also knew which animal it came from. He pointed out birds, identified deer rustling in the shrubbery, he showed me a ginger plant that you could squeeze and water would come out of it, and told me about how this is a good water source for thirsty guides and forest-dwellers when they get lost. He pointed out insects I would have missed; busy little dung beetles, wasps' nests, centipedes and millipedes, caterpillars, butterflies...all of which he could identify by species. He taught me to look out for Kingfishers by the waterside, to spot hornbills, and to identify primates by their sounds."
I think it was Klaus’ relationship with nature that formed his philosophy of life and death and made Buddhism so easy for him to embrace. One of the things I admired most about him was his quest to grow personally and spiritually while he was dying and that remarkably his condition didn’t keep him in despair. He experienced depression and was taking anti-depressant medication, but most of the time he maintained a positive attitude.
Sometimes friends would visit Klaus, one of them, who he knew when they both worked in Nepal, and a friend of mine, who teaches at the Buddhist University in Chiang Mai, arranged to bring four Nepalese monks to Klaus’ house to chant for him. I arrived that day just as a van pulled up with our friends and the four Monks. We all gathered on Klaus’ veranda and after introductions, the monks chanted for almost an hour. I took some photos of the monks as they were chanting, but the best picture was of Klaus’ face beaming with joy.
Around this time Elise, who in addition to her many talents is a certified Reiki practitioner, gave Klaus a Reiki session. Reiki is a form of alternative medicine called energy healing. Practitioners use a hands-on healing technique that transfers “Universal energy” through the palms of the practitioner to the patient. Klaus loved receiving the Reiki treatments. He looked forward to his weekly sessions and his relationship with Elise deepened during those sessions which continued until he moved back to McKean a week before he died.
Nothing changed much during the following weeks, but when I saw Klaus about a week before Christmas, something had shifted. He looked and acted as if he was weakening, and he said he felt weak. He told me his life had diminished to a point in which the quality was no longer there, and he felt like he was too much of a burden for everyone around him. He was spending more of the day in bed and asking for morphine more often. He woke up the next morning and told Heidi and Evelyn he wanted to go back to McKean. That afternoon, Heidi called for an ambulance and he was moved back to the same room he had stayed in during his last time there.
The first time I visited him back at McKean, he was hooked up to an IV for his medications, and a nurse was emptying a food bag into his feeding tube. He seemed to be more at peace than he looked when he was at home a few days before. I sat with him for a while as he drifted in and out of sleep and I left him sleeping. Early the next morning P, the head nurse, called and told me Klaus was not doing well and that he wanted me to come to the hospital.
When I walked into Klaus’ room, he smiled. After I sat down next to his bed, we reconnected non-verbally as we grasped hands. After the nurse had given him his morphine and left the room, Klaus moved his lips soundlessly but I could understand his words, “Help me to die as soon as possible.”
A few minutes later, Dr. R came to visit Klaus. I asked her if it was legal in Thailand, when someone has a feeding tube, to stop feeding? She said if the patient requests it, she can order the feeding tube to be removed. As soon as Klaus heard her say that, he motioned to me to give him his note pad and pen, which I did. I held the pad so he could shakily write, I want to die as soon as possible. Dr. R took the note pad from his hand, and after a glance, she waved away the nurse who just arrived with a fresh feeding bag.
After the feeding bag was removed and his recent dose of morphine kicked in, Klaus breathed a sigh of relief, relaxed his body, and signaled to move his laptop so he could reach it. He selected a piece of music he liked and the music filled the small room. We continued to hold hands, with only a brief pause when Unchai arrived. About half an hour later Heidi walked into the room, just having returned from Bangkok. Klaus’ face lit up when he saw her as his wish had been for her to be with him when he died. I stood up, bent over the bed and hugged Klaus, said good-by to Unchai, and Heidi walked me to my car. Klaus died early the following morning, with Heidi alongside him just as he had wished.
After Heidi and I met at the tea shop and she told me she wanted to become a “Death Doula,” I wrote and asked her why and she responded:
"Through my dad's dying process I realized what a tremendous amount of physical, emotional, and also spiritual ‘intrusion’ such a situation is in the lives of the dying person and their family.
I got to experience firsthand, not only how difficult it is but also what a tremendous difference it can make to have someone there who is unafraid of death and dying, and who can be there as a supportive, kind and loving presence, even to a complete stranger.
I got to experience what a deep and lasting positive impact end-of-life care can make and how a small group of people can make such a huge difference. And as someone who now has experience with this, I would like to pass this on to other families myself."
All of us will die. But, some of us seem to leave more peacefully than others. Klaus was able to accept palliative care sooner than most. He had something to live for, something to believe in, and a support team to help him to live life fully as he could until the end. His way is not for everyone, but Klaus was a teacher of what I think we all want when our time comes to leave this life — a graceful passage.
March 10, 2020