“This is the way the world ends
Not with a bang but a whimper.”
“The Hollow Men” – T. S. Eliot

My fraternal twin sister, Deb, died of complications from liver failure at 7:49 a.m. EST on February 29, 2020. I am heartbroken writing this.

T.S. Eliot is one of my favorite poets, and although I love the depth of “The Wasteland” and the profundity of “The Love Song of J. Alfred Prufrock,” “The Hollow Men” has always been my favorite. The last two lines always run through my mind when someone I know dies, as does Ecclesiastes 9:5-6 – “For the living know that they will die; but the dead know nothing, and they have no more reward, for the memory of them is forgotten. Also their love, their hatred, and their envy have now perished; nevermore will they have a share In anything done under the sun.”

The picture above captures the essence of Deb that I loved. She was funny, goofy, and more optimistic about things than not, seeing the glass half full, most of her life. Even though we were twins, I was the opposite in many ways. I could be funny, but it was usually without intending to be, because I was so serious and literal about things. I never felt comfortable being goofy. And I was much more pessimistic, seeing the glass half empty, about life in general.

Those differences sometimes brought conflict between us, but there was no doubt we loved each other.

Her alcoholism was the real wedge between us. When she was younger, she just drank a lot, laughed a lot, and went and slept it off. As she got older, though, and was drinking much more heavily, confabulation became a huge issue as did a mean streak that could be vicious and brutal. She harangued me a lot.

When I couldn’t bear the stress of it anymore, I simply disappeared. And, although we communicated (I used a social media account so she couldn’t get any IP information to trace where I was) from time to time, that estrangement last for four years, without her knowing where I was or what I was doing.

In December 2018, Deb messaged me saying that she’d gone in for a liver biopsy because her liver enzymes were abnormally high. She also said, “I guess I’m never going to see you again.”

I quite frankly didn’t know what to think. Was this confabulation? Was this a way to try to get me to see her? I knew, even then, if this were not real, that given the number of concussions Deb had had from drunken falls over the years, that dementia was in her future eventually.

I also didn’t want to have any regrets if Deb was really telling me the truth. So I set up a non-traceable way to call and text her and made the phone call.

When we talked, she said she’d been having a few balance problems. It was nothing serious, but a comprehensive blood workup had shown she had elevated liver enzymes. She said she was waiting for results of the biopsy.

We talked several days later and the results showed Stage 2 liver disease. One of the problems with liver disease is that toxins don’t get cleared from the body. Ammonia, for example, goes to the brain (instead of being eliminated through the bowels) and a type of dementia, caused by hepatic encephalopathy, occurs.

By April 2019, Deb was having problems with blood pooling and she developed sepsis in one of her feet. She ended up in the hospital for several days, with IV antibiotics and B1 being pumped through her veins. She told me the doctor told her that if she didn’t stop drinking, she would die.

Deb was an alcoholic, so she didn’t stop drinking. In June 2019, she was driving and pulled too far out in the road to make a turn and was hit by a car, causing significant front end damage to her truck. She said she didn’t think she was that far out in the road.

Balance became a real problem during the summer. Falls were frequent. Deb went to take the garbage out to the curb one day and fell on her face in the driveway. A passing neighbor saw her and got her to the emergency room.

Physical therapy began to try to help Deb with balance, but her central nervous system was getting less responsive.

In August 2019, Deb drove to the grocery store and, in trying to park her truck, she sideswiped the car beside her. Deb said she didn’t know how it happened, because she thought she had plenty of room. The keys to the truck were taken away.

I visited her in September 2019. Deb was still able to walk, but tired easily, and used a walker when she felt more unstable. I was shocked at how thin she was except for the fluid buildup in her abdomen (ascites) from liver failure. Deb was coherent, but said she was “winding down.”

I offered to help her with caregiving. She accepted. I said I’d be here by the end of October 2019.

Two days after my trip in September, Deb had an appointment with a second gastroenterologist and a neurologist. She was diagnosed with cirrhosis of the liver (final stage of liver disease) and the brain scan showed significant atrophy, not unlike that of Alzheimer’s Disease. She was given three to six months to live.

The decline from the time I got here in October to February 29 was dramatic. Deb had been enrolled in hospice three days before I got here. The hospice group – Palliative and Hospice Care (Charlotte Region) – was phenomenal, and what amazed me most was how non-judgmental and compassionate and caring they were every step of the way.

Alcoholism is an addiction. Its origins are genetic, environmental, and circumstantial. We all fight addiction to something, and most of us don’t realize we’re either struggling to fight an addiction or we’re all in with an addiction.

You can be addicted to anything. It’s a craving that literally drives your life. It might seem to have good results, but it can often feel unfulfilling because the motivation behind it is off kilter or it simply never fills whatever is driving the craving. It creates great harm, if not without, at least within us.

But alcoholics and drug addicts are seen as somehow being different from the rest of us. They are not. Their addictions are just more obvious and the results, inside and outside, much more visible.

Deb stopped eating and drinking anything on Sunday, February 23, 2020. She refused to eat or drink anything that day and on Monday. By Tuesday, she was become less responsive. By Wednesday, hospice said she was actively dying.

I was sitting with her yesterday morning for several hours. I rubbed her head and talked with her, watching her rapid, shallow breaths. About 7:30 a.m., I saw a change in her breathing and realized we were there. I kissed her and told her I loved her before she took her last breath.

I miss Deb as I knew her. As you always said, Deb, “there’s a song for everything.” I think of you and the lines from Vince Gill’s “Go Rest High on That Mountain,” – “I know your life/On earth was troubled/And only you could know the pain.”

I will miss you until I see you again. Until then, Deb. I love you.