by Charles Bankhead

My oldest sister died recently. She spent the last three years of her life in a nursing home, trying to hold on to reality and her dignity as her mind and body betrayed her.

Barely five feet tall, my sister Peggy had a big heart and a vibrant personality that made her seem much taller. I have a lot of fond memories of her, many of which involve her wicked sense of humor, which probably shocked people who didn’t know her well and delighted those who did. Sometimes her humor was at its best when life was at its worst for her.

In her early 40s, Peggy learned that she had biliary cancer. Her surgeon decided that a Whipple procedure offered her the best chance of survival. If you’re not familiar with the procedure, let’s just call it major abdominal surgery and leave it at that, without all the gory details. A couple of days into her recovery, my sister’s surgeon came by to check on her.

With the benign smile of someone who cuts people open for a living, the surgeon asked, “How are we doing today?”

My sister sized him up for a moment and then said, “I don’t know about you, but I feel like someone opened me up and yanked my guts out.” She paused before adding, “Aside from that, I guess I’m OK.”

As he left, the surgeon jotted something on the chart, probably a reminder not to ask stupid questions.

My sister smiled and winked at me, obviously pleased with herself.

On the fifth anniversary of her surgery, my sister showed up at the surgeon’s office for her annual check up. The surgeon told her that he had nothing but good news: She looked great, all her lab work was normal, and he could find no evidence of cancer anywhere. For all intents and purposes, she was cured. He said he planned to write a paper and try to publish it in a major medical journal.

“So, how many patients have you cured with this operation?” my sister asked.

Caught off guard, the surgeon was momentarily open mouthed but speechless. After clearing his throat a couple of times, he said, “Well, you’re my only patient who has lived this long.”

Now it was my sister’s turn to be open mouthed and speechless. The surgeon broke the awkward silence by asking, “Is something wrong?”

“I think I must have missed something,” Peggy replied. “Could you go over the part about the good news again?”

A few years later, Peggy’s husband died suddenly. Just as suddenly, she faced an even more daunting challenge than any cancer could pose. Side by side, the two of them had journeyed through cancer and everything else life threw at them. Now, my sister faced the rest of her life without the love of her life. I don’t know whether the term “soul mate” had come into use at the time, but if ever it applied to two people, Peggy and her husband, Bobby, had earned it. When he died, a part of her died with him. A very large part.

We went to the funeral home for one last visit. As we stood by the casket, I couldn’t begin to imagine all the thoughts and memories that must have been flooding my sister’s mind. Peggy and Bobby shared much in their life together, including a fondness for jokes. Funny, silly, bawdy, borderline-obscene jokes. They loved sharing all kinds of jokes with each other.

Peggy and Bobby had a particular fondness for Aggie jokes. If you’re not familiar with Aggie jokes, then imagine Polish jokes, or Kentucky jokes if you’re from southern Ohio, or Newfie jokes if you live in Canada. Imagine the same jokes but with Aggie substituted for your favorite target of humor.

In the midst of profound grief, my sister’s mouth twitched at the corners, as the slightest of smiles formed. She leaned over and whispered, “Did you hear about the Aggie who thought oral sex was a college in Oklahoma?” It was the last Aggie joke Bobby had shared with her. We both chuckled, and then I put my arm around her as she wept.

Two decades later, I visited my sister for the first time in the nursing home. She seemed lifeless, like someone waiting to die and wondering why it was taking so long. I could not imagine how she could survive for long in that state. Yet, when I returned a few months later, she had regained some of her identity, along with her sense of humor.

As my wife and I wheeled her around the corridors of the home, Peggy smiled and greeted other residents. We came upon a woman in a wheelchair, sitting by herself. My sister smiled at the woman and said, “Hello, Mary. How are you today?” Mary didn’t respond. Mary was long gone, whisked away by dementia to some faraway land.

Without missing a beat, my sister continued the conversation: “Why, I’m fine, Peggy, thank you for asking. How are you?”

As my wife and I laughed out loud, Peggy smiled and winked.

The last time I visited Peggy, she seemed so small and fragile. Her memory had wandered pretty deep into that faraway land. Yet, her eyes still had some sparkle and she could still give a piece of gum a good workout.

On most days, Peggy refused to eat, and she let the staff know that she didn’t appreciate their trying to force food on her. As my wife and I sat at a table and talked with her, an aide approached, holding a cup of pudding. My sister’s eyes suddenly lost their sparkle, and she slouched in the chair, her mouth sagging open every so slightly. She looked straight ahead but saw nothing. Or so we thought.

The aide stuck a spoonful of pudding near my sister’s mouth and said, “Would you like some of this nice dessert that we have today? It’s yummy.”

Peggy remained in her trance-like state. The aide sighed and set the cup and spoon on the table as she left. When the aide was out of view, my sister turned to my wife and me, rolled her eyes, shook her head, and smiled.

My sister taught me that laughter is good for the soul, even during life’s most difficult times. Perhaps especially then. It’s a lesson that I hope I always remember.

Charles Bankhead is a staff writer at MedPage Today and blogs at In Other Words, the MedPage Today staff blog.

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