Wisdom to guide the end of life

December 18th, 2017

Steve Bloom loved poetry, music, birds and his family.

In this photo, Mike Bloom stands in front of a lake in Patagonia where he and his wife, Mike, went to go birding in 2015.
Steve and Mike Bloom loved traveling the word together to see birds and beautiful scenery. One of their trips took them to Patagonia in 2015. Photo courtesy of Mike Bloom.

As Steve lay in his home during his last hours, his wife, Michele “Mike” Bloom opened the window of their bedroom so Steve could feel the fresh air on his face. Beyond the deck, the creek that runs behind their home shimmered in the spring sun.

Next to the window, the forsythia bushes were just beginning to show their yellow blossoms and the goldfinches jumped from branch to branch.

“The birds sang to him all day long,” Mike recalled. “They have the sweetest song.”

No one was ready to let Steve go.

He was beloved and brilliant. He had a doctorate in clinical psychology and worked as a consultant, helping high-powered CEOs and regular folks alike see the best in others and tap into their own strengths.

He performed with folk music groups throughout his life and often strummed tunes on his guitar, encouraging friends to sing along. He read a poem out loud before dinner every night. He voraciously studied his Discover and Smithsonian magazines and loved solving crossword puzzles, even the toughest ones every week in the Sunday New York Times.

Steve, 74, spent his career helping others navigate tough paths.

Then, when it came time for Steve and Mike to grapple with the most painful challenge of their lives, Steve gave his family a profound gift. He thought carefully about all that made his life meaningful and enunciated his thoughts clearly. Both he and Mike had created advance directives to spell out their wishes.

Before Steve had to have heart surgery last fall, Mike asked him to clarify even more precisely what living meant to him. He thought overnight about his answer, then gave Mike three tenets:

  • To be able to think and communicate and read.
  • To be able to relate to the people he loved.
  • To be useful in the world somehow.

Steve’s insights proved invaluable as Mike had to help her husband navigate his tough path. Supporting her in their painful journey were many loved ones and a caring team from UCHealth’s Palliative Care program. The interdisciplinary team that includes doctors, social workers, nurses, chaplains and music therapists provides guidance on treatment options and pain management along with emotional and spiritual support for patients and family members coping with serious illnesses.

Contrary to popular belief, palliative care is not limited to hospice care, which focuses strictly on end-of-life options. Rather, palliative care can help patients find meaning and hope while boosting their quality of life.

While Steve’s death far too soon left all who knew him deeply sad, palliative care experts helped provide solace amid the sorrow.

A brain tumor and the determination to live

Three decades ago, when Mike and Steve were freshly married in their 40s and parenting three teen boys between them, a rare tumor surfaced in Steve’s brain.

Steve and Mike Bloom in a photo when both were in their 40s. Later, the couple would have to ask, "What is palliative care?"
Steve and Mike Bloom soon after they were married. Photo courtesy of Mike Bloom.

The couple teamed up to confront that crisis as they faced new health challenges in the decades to come: united and optimistic.

A surgeon removed the entire tumor, known as a craniopharyngioma, back in 1987. But the surgery left Steve without pituitary function. He had to take replacement hormones for the rest of his life and both he and Mike tended his health as carefully as they nourished their marriage, high-powered careers, their gardens, friendships and their family, which eventually grew to include five grandsons.

Post-surgery 30 years ago, Steve declared his vision for the future.

“I’m not going to let this make me sick.”

And so he didn’t.

The couple traveled to 32 countries around the world, sharing their passion for birding. Mike kept a list of more than 3,000 birds they had seen from Costa Rica to Botswana. Steve photographed owls, hummingbirds, tropical tanagers and the other beautiful animals they saw on their travels.

“We were birding buddies,” Mike said.

Professionally, they thrived too. Steve had served as director of Medical and Mental Health Services for Colorado’s Department of Corrections and later became a consultant who worked with leaders around the U.S.

In this photo, Steve Bloom is shown bird-watching with his binoculars.
Steve and Mike Bloom shared a passion for seeing birds, first in Colorado, then around the world. Photo courtesy of Mike Bloom.

Mike, too, was an expert in behavioral health, then later became the founding dean of The Women’s College at the University of Denver.

Steve was always his wife’s biggest cheerleader and like his clients, she benefited from his wisdom. Once she remembers coming home from work and complaining about a difficult colleague.

“I suppose she’s doing the best she can,” Steve said, instantly giving Mike a fresh take.

“If I was frustrated and judgmental and certain I was right, he’d provide a different perspective,” Mike said. “I was always astonished by his ability to see the best in people.”

Steve once gave her critical advice to be an effective leader: “There’s a difference between being right and being effective.”

Heart failure, then an infection

For years, the couple kept Steve’s health challenges at bay. Then in recent years, he developed heart disease and last fall when his heart failed, he traveled out of state for surgery.

About three weeks later, Steve and Mike returned to Colorado. He seemed to be recovering well.

Then, one day in January, he decided to get back to work and did a conference call. Moments after he hung up, he told Mike that he wasn’t feeling well. He’d developed a fever and severe chills.

Mike knew she had to jump into action quickly as she had done so many times before. Because Steve’s system could easily get out of whack, Mike always carried a steroid shot and learned how to administer it. She had saved her husband’s life many times before. Paramedics arrived within minutes and said that Steve was septic and rushed him to the ER. His doctors then transferred him to UCHealth’s University of Colorado Hospital, where cardiology experts took over.

A serious infection had attacked Steve’s body, but at first, doctors struggled to find the source. They finally found that this infection had lodged itself in Steve’s new heart valve and doctors said he would need a new one.

“The surgeon told us the odds of death were 100 percent without the surgery and 50 percent with it,” Mike said.

Steve responded with his typical positive attitude.

“Then let’s do it.”

Unfortunately, Steve did not bounce back well from the surgery. He had spent two weeks in the cardiac unit, then after the heart surgery, went to the ICU, where he would spend six more weeks. No sooner would doctors tame one problem than another challenge would arise.

With each new complication, Steve’s rare pituitary condition interfered with his recovery. Medications that would have helped other patients caused adverse reactions in Steve.

“They were always walking such a fine line with him,” said Mike.

She found herself more at sea as she watched her husband struggle.

“He swung between being asleep, unaware, agitated, but not in pain to being almost unarousable. Then, at other times, he was awake, alert, talking and wanting to know what had happened to him,” Mike said.

Exhausted, Mike nonetheless arrived at the hospital by 6:30 every morning so she could be there for the doctors’ rounds. She had always served as her husband’s informal care coordinator and supporter-in-chief. His determination not to be sick always had prevailed in the past. This time, Mike and Steve both suffered as he continued to decline.

“Over time, the up and down pattern was unrelentingly down,” Mike said. “And I lost any control I might have thought I had.”

By Mike’s side throughout Steve’s health ordeal were dear friends and family.

Once, when one of Steve’s grandsons heard that Grandpa Steve was having trouble telling his nights from days, the 5-year-old drew him a picture. On one side, he drew Steve with plants and clouds and rockets on a white background. On the right side, he drew a nightscape with stars, planets and the moon.

“The picture had Steve in both, so he could see himself in the day and the night,” Mike said. “It was a map.”

One of Steve’s nieces visited the hospital frequently. Steve hated his feeding tube and wanted to pull it out. To keep his hands busy, his niece brought little stuffed animals – a gray cat once and a crouched bear another time.

The Blooms’ close friend, Sharon Sherman, was with the couple every step of the way.

“I watched them go from traveling all over the world, birding all the time, entertaining and having dinner parties, going out to plays and musical things to being absorbed by this illness,” Sherman said. “It was so hard to watch.”

Two weeks after Steve’s admission to the ICU, Mike happened to see a poster on a wall about palliative care. She knew nothing about the program and hadn’t realized Steve could receive support. She was hardly alone in asking, “What is palliative care?” Mike sought help right away for help and within hours, was meeting with the team.

Their approach proved transformational for the Blooms and eventually led Mike to take her husband home, where the forsythia blossoms and the goldfinches awaited him.

The power of listening

Mike met the palliative care providers in a quiet room at the hospital, where they first asked a simple question: “Tell us your story.”

For Mike, it was a great relief to be asked. She spoke uninterrupted for 45 minutes.

She told them about Steve’s remarkable talents and his caring demeanor, their happy marriage, their careers, their travels and how much their community mattered to them. For decades, Steve had served on the board for a drug treatment center and the couple had long supported the Bird Conservancy of the Rockies.

Years earlier when Steve had lived in Evergreen, he had founded a Jewish congregation there called Beth Evergreen. She and Steve still celebrated his Jewish heritage and were now active members of the First Universalist Church in Denver. Mike was a masterful fundraiser who had led the drive to raise $10 million for the light-filled Women’s College building at the University of Denver.

Mike also told the palliative experts about Steve’s advance directive and his definitions for a good life. They let Mike know how lucky she was that she and Steve had so thoroughly discussed such difficult issues.

Mike Bloom is shown near the creek outside her home. She's holding a bag of rose petals that she and the grandchildren spread in the creek.
Mike Bloom saves rose petals. When the grandchildren come over, she helps them throw the petals in the creek near her home as they share memories of ‘Grandpa Steve.’ Photo by UCHealth.

And she shared a story that one of Steve’s sons, an organic farmer in California, had told his dad a week earlier in the hospital.

“A time comes when you have to stop doing on the land all that you’ve been doing and hang up your tools and let nature take its course.”

When Steve told Mike the story, she asked if he was ready to “hang up his tools.” Was it time for her to put the brakes on all the treatments and let “nature take its course?”

“No,” he told her. But he wanted her to remember the story.

“It became a metaphoric way for us to talk about the choice that would eventually come,” Mike said.

Everyone listened intently, including their palliative care doctor, David Nowels.

“I learned about the depth of their relationship and how important and beautiful it was to each of them, but also how much pain they were experiencing. It helped me understand the motivation for all they had gone through,” said Dr. Nowels, a family medicine doctor who practices both at the UCHealth A.F. Williams Family Medicine Center in addition to working with the palliative care team in the hospital.

“Mike had developed deep expertise about Steve’s disease,” Nowels said. “In the past, they’d always been able to fix all the problems that had come along. That was driven by their deep love for one another and how incredibly bright and committed they were. That came out in so many ways as I got to know them.”

Providing comfort and support to the entire family is one of the core aims of palliative care, said Dr. Nowels, who is also an associate professor of Family Medicine at the University of Colorado School of Medicine.

What is palliative care?

“Palliative care improves patients’ lives and often families’ lives whether they are in the last stages of life or not,” Dr. Nowels said. “Our goal is to help them live the best life possible. We listen deeply to their goals and values to figure out how we can improve their experiences whether they are dying in the short term or many years down the road.”

Palliative care provides support that includes:

  • Treating pain.
  • Providing emotional and spiritual support.
  • Helping people who are suffering find the strength to carry on with life.
  • Maintaining hope.
  • Enriching communication between patients, caregivers and medical providers.
  • Providing guidance to help patients and families make difficult decisions about treatment options.

For Mike, the palliative approach brought great relief.

The team instantly understood that Steve was a gentle and wise soul. They gave him the dignity of calling him Dr. Bloom. And they created a set of guidelines to hang in Steve’s hospital room so the many specialists could provide better care as they tried to save Steve’s life. These included detailed descriptions of Steve’s rare adrenal condition so all the medical providers would keep his unique physiology in mind.

The palliative experts also helped Mike reframe a Do Not Resuscitate order with gentler language: “to allow a natural death if Steve’s heart stops or he stops breathing.”

Among the most soothing visits was one from the team’s music therapist. She brought her guitar and played some of Steve’s favorites like John Denver’s “Sunshine on my Shoulders” and “Rocky Mountain High.”

“It was the most alive and awake I had seen him,” Mike said.

The therapist was pregnant and the night after she visited Steve, she delivered her baby, so the Blooms’ friends and one of the hospital chaplains stepped up to provide more music. With chaplain, Parker Ebling-Artz, Steve sang a duet of James Taylor’s “Fire and Rain.”

A harpist from the Blooms’ church came and another friend visited with his guitar and played Pete Seeger tunes.

“This gave him pleasure and a sense of himself. It was an oasis for us both,” Mike said.

A chaplain and social worker then visited Mike and Steve frequently. The chaplain carefully selected readings for his Jewish-Unitarian patient and settled on selections from the Psalms along with Mary Oliver poems.

More than anything else, the palliative care team reassured Mike that she was making the right choices.

“They helped me let go and go home and rest every night,” she said.

Nowels said the University of Colorado Hospital palliative care team is one of the most robust programs in the country. All the providers have special training in palliative care and the program is certified and accredited through an independent non-profit called the Joint Commission.

“The hospital has made deep commitments to our service over time. Growing our team has been a huge benefit to our patients,” Nowels said.

Letting go

While Steve’s ICU doctors kept doing everything in their power to help Steve recover, it soon became apparent that he was not living by the tenets he had outlined. He often was struggling with the basics: eating, sitting up and walking. Instead of getting stronger, he was declining.

“The hardest aspect of this journey was seeing him lose his sense of self, seeing his brilliant mind become so confused and frightened, seeing him in so humiliating and dehumanizing a situation,” Mike said.

Even with all the treatment, she felt she was losing Steve, so she asked the ICU and Palliative Care providers to meet together with her. Steve was conscious and able to participate in that meeting.

The ICU doctor told the couple that he believed Steve could recover; still, he acknowledged that the process would be long and difficult. And Steve might never regain some of what he had lost. Dr. Nowels and his team helped the Blooms focus on Steve’s wishes and reminded both of them that they were free to make choices about interventions they did or didn’t want.

Following the meeting, Steve reaffirmed his wishes. He seemed to know he was dying. While it clearly broke his heart to know he was leaving Mike alone, he knew it was time to “put down his tools.” He wanted to go home.

That evening, nurses moved Steve to a special area of the hospital devoted to Palliative Care so they could stabilize him. His room faced west and a brilliant sunset painted the sky in hues of orange, purple and pink.

During that first night, Steve woke up at 4 a.m. Mike had been staying in the room. Steve asked her to come crawl in the bed with him.

“He had dreamed he had died. I was there to comfort him,” Mike said.

After one more night in the hospital, Mike was able to grant her husband’s wish and take him home, where Steve’s family and friends surrounded him. Dr. Nowels was there too, this time in his capacity as Steve’s hospice doctor. Loved ones sang “Morning Has Broken” and read poems to Steve.

Peaceful in his familiar surroundings, Steve died on March 24 as Mike held him in her arms.

‘I can fly’

The changes of the seasons have proved especially tough for Mike. She and Steve loved tending the garden together. They watched as the colors evolved and new birds arrived.

To bring some hope into her life, Mike decided to get a puppy. She’s a Cavachon, a mix between a Cavalier King Charles Spaniel and a Bichon Frise. The puppy’s name came from a little sticky note that Mike had long ago written to Steve: “You are my sunshine.”

Mike Bloom holds her new puppy, Sunshine, in this photo. After asking, "What is palliative care," she got help from a team that supported her through her husband's death.
Mike Bloom outside her home with her new puppy, Sunshine. Photo by UCHealth.

Sunshine, the puppy, is about four months old now and loves snuggling and sashaying around the house.

“She gives me a reason to get up. She makes me laugh. She makes me smile. The house is terribly quiet. I’m not as lonely now,” Mike said.

The puppy trainer noticed that Sunshine does well with strangers and is eager to learn new tricks. She suggested to Mike that Sunshine would be a perfect therapy dog. During Steve’s hospital stay, a volunteer cheered Steve up when she brought her schnauzer for a visit.

Now, Mike is planning to get Sunshine certified so both of them can return to the hospital and bring some warmth to patients who are struggling.

Mike thinks back often over this year’s tough times. Losing her soul mate has been devastating of course. Mike also grieves for all that Steve will miss.

“It was the most beautiful fall I can ever remember. All the colors were really vivid. The leaves stayed on the trees for such a long time,” Mike said.

When the grandchildren come over, Mike hands them rose petals that she saves and they toss them into the creek nearby, sharing their memories of their grandpa and watching as the petals float downstream.

Sorrow often overwhelms Mike. But every once in a while, she experiences a moment of humor or mystery that feels like a little wink from Steve.

Over the summer, Mike was on her deck eating breakfast one day. Stella, the cat, was sitting on the railing nearby. Mike and Steve often saw hummingbirds near their home. But this was a rare one called a Calliope. Stella watched the bird, mesmerized. Then for a moment, the hummingbird swooped down and put its bill right on the cat’s nose. The cat froze while the Calliope seemed to give it a kiss. Mike couldn’t help but laugh and think of Steve.

Another time, Mike was walking out to her mailbox. Steve always used to tell the story of Dumbo, a Disney elephant who wanted to fly. Dumbo manages to soar with a single feather. He believes it’s magic, but drops it and learns he can fly simply because he believes in himself. Steve used the feather story as a metaphor with clients. If they believed they could succeed, then they could – with or without a bit of magic.

On the way back from the mailbox, out of the blue, Mike saw a large black feather right at her feet. She hadn’t seen it seconds earlier in exactly that spot and wondered where it had come from. It seemed like a little gift from Steve.

“I don’t imagine they’re visits. Whatever they are, they’re beautiful,” Mike said. “Wherever that feather came from, it reminded me that I can fly.”

 

About the author

Katie Kerwin McCrimmon is a proud Colorado native. She attended Colorado College, thanks to a merit scholarship from the Boettcher Foundation, and worked as a park ranger in Rocky Mountain National Park during summer breaks from college. She is also a storyteller. She loves getting to know UCHealth patients and providers and sharing their inspiring stories.

Katie spent years working as a journalist at the Rocky Mountain News and was a finalist with a team of reporters for the Pulitzer Prize for their coverage of a deadly wildfire in Glenwood Springs in 1994. Katie was the first reporter in the U.S. to track down and interview survivors of the tragic blaze, which left 14 firefighters dead.

She covered an array of beats over the years, including the environment, politics, education and criminal justice. She also loved covering stories in Congress and at the U.S. Supreme Court during a stint as the Rocky’s reporter in Washington, D.C.

Katie then worked as a reporter for an online health news site before joining the UCHealth team in 2017.

Katie and her husband Cyrus, a Pulitzer Prize-winning photographer, have three children. The family loves traveling together anywhere from Glacier National Park to Cuba.