Life, death and those left behind

It started in late June, with nothing more than mild abdominal pain. Nobody around Cleo Costa thought anything of it.

But within two weeks, doctors would tell the 81-year-old homemaker from Carson City that her death was imminent.

When it became clear that she would not live much longer, the Costa family prepared. They prepared funeral plans and an obituary. But mostly they prepared themselves for a process that hundreds of families in Carson City will also experience this year. An average of two people die each day in Carson City, but as common as death is, it is still one of the most devastating experiences a family will go through.

Many, like Cleo Costa, have lived long and productive lives, raised families and left behind proud legacies. Costa, for example, celebrated her 49th wedding anniversary with her husband, Louis Costa Sr., in May. They raised eight children and doted over 17 grandchildren and 41 great-grandchildren. She enjoyed crocheting afghans for the homebound, baking cakes for her family and friends, playing keno and bingo and was a longtime member of the Carson City Raiders Booster Club.

Carson City loses people like her every day. Families struggle with the loss and the emotions that always result. Often they find themselves unprepared and afterward end up with regrets including questions they never asked and stories they never wrote down.

With that in mind, Rhonda Costa-Landers, a reporter at the Appeal, let us follow the process she and her family went through this month when they were forced to say goodbye.

• • •

Cleo Costa's children asked her if she wanted to go home. As soon as they said the word, she nodded and repeated, "home."

It was Saturday, July 14, and Cleo Costa had been in Carson Tahoe Regional Medical Center for 10 days. Her husband and children had decided to stop medical treatment and take her home, where with the help of St. Mary's Hospice Care, she would spend her final days.

The news was especially hard for her daughter, 44-year-old Costa-Landers, of Dayton, who spoke to her mother at least four days a week. They shared stories about life, laughed at the odd things their spouses did and took joy in enjoying each other's lives. To Costa-Landers, Cleo was more than her mom, she was a close friend.

In early July, doctors told her the diverticulitis - which she had been diagnosed with several months before - was flaring up. An infection set in soon after.

But the family remained hopeful, after watching what their mother had survived during the last five years, this was nothing. Cleo had already made it through open-heart and gall bladder surgery, had her left knee replaced and beaten bladder cancer.

But nothing was helping the infection and four days after entering the hospital, Cleo went in for surgery.

Before he operated, Cleo's doctor asked for a word with her husband and Costa-Landers. He told them odds were Cleo wouldn't survive the surgery.

Costa-Landers notified her siblings, several of whom drove more than four hours to be with their parents.

While she survived the surgery, the infection continued to spread through her body.

Soon after her kidneys began to fail and the family contacted hospice care, which would help Cleo to die comfortably.

• • •

As the two paramedics carried her through the door, Cleo couldn't help but smile. Trailing behind her, daughter Christine Redding, of Dayton, carries four cans of liquid nourishment, enough food to last Cleo for the rest of her life.

"You're home mom, home for good," Redding, 59, said after the paramedics put her in her bed.

Five of Cleo's eight children are there.

Redding and Costa-Landers are joined by two siblings from Northern California and one from Las Vegas. One daughter chooses not to take part because of a long-standing family disagreement and another daughter from Arizona stays with her husband, who is in declining health.

Glenn "Dusty" Costa, 41, lives with his parents but doesn't want to be around. He comes home only to change clothes and leaves again without exchanging words with his siblings.

Hospice workers tell the family Cleo is exhibiting signs that she is ready to die and it could be in the next couple of days.

Louis Costa Sr., who goes by Louie, worked to straighten the house. Sitting down or being still draws an almost painful look and with his children tending to his wife, Louie struggles for distractions.

He spends 15 minutes replacing the AA battery of a clock.

"It's been slow for years, I don't know what's wrong with it."

When he's done, he starts to stabilize the window air conditioner until his wife is settled.

• • •

Louis Costa Jr., of Vallejo, Calif., known to his siblings as "Sam," doesn't like doctors and especially hospitals. He spends much of Monday and Tuesday by his mother's bedside. The rest of the family credits his wife, Gwen, with helping give him strength.

Two years ago, Gwen was diagnosed with a brain tumor. When the 48-year-old Sam first went with her to the hospital, he collapsed in the elevator. He got over his fear and spent the next month by his wife's side in the hospital.

The siblings took turns sitting with their mother, sitting by her side or stroking her hands. Larry Redding, of Las Vegas, sat quietly. Christine Redding, Costa-Landers and Martha Thompson, of Vacaville, Calif., stroked her hands and talked to her. Dusty spent only moments in the same room with his mom.

Cleo unconsciously picked at her clothing and outstretched her arms as if looking for someone above her to lift her up. She began having conversations with her mother, who died years before.

At the same time, her blood pressure steadily declined, her extremities felt colder and her breathing became labored. Thompson, 55, calmed her by reading from the Book of Psalms.

Louie went to Walton's Chapel of the Valley to plan Cleo's funeral service. Following his wife's wishes, he chose cremation, with her remains to be placed in eight small urns - one for each of the children - and the rest to be placed in a larger urn for him. He hopes that when he dies, each child will get a similar urn with his ashes and the remainder will be mixed with his wife's.

He is told that even though she will be cremated, the law requires her body be placed in a box, anything from cardboard to elegant wood caskets.

The family also decided to have a DVD made. The digital video scrolled through photos of Cleo while a selected song played.

They chose "Unforgettable," the duet version with Nat King Cole and Natalie Cole because it was 18 seconds longer than the original, meaning more time for the pictures to be seen.

•••

A small urn with the ashes of her first hospice patient sits on Katie Grimm's desk, the biggest reminder of why she is a hospice worker.

Grimm, who is the clinical manager for St. Mary's Hospice Program, said that when she joined the program six years ago, she developed a special attachment to her first patient and the immediate family. It convinced her that is where she is supposed to be.

Katie visits the Costa family each morning on her drive from Gardnerville to Reno and each night on her way home.

"It's really a gift to be able to have this experience, to be able to make them comfortable and say goodbye knowing they are OK," Grimm said. "That's what hospice is for. We are not trying make people give up hope, we are simply changing it to a hope that they are comfortable and safe."

With hospice workers, Grimm said, it is often a personal experience that causes them to go into hospice.

St. Mary's handles approximately 700 hospice cases a year.

"I'm amazed at how personable the hospice workers have been. They are complete strangers who become instant friends and instantly important," Costa-Landers said.

•••

At 4 a.m. July 19, Cleo had a burst of energy and asked to talk to her children. Before sunrise they gathered at her bedside and Cleo told them that she loved them, including her daughter Kathy Giafrancisco, who is able to talk to her mom on the phone from Arizona.

Her children tell her it's OK to let go and promise to get along and take care of their dad.

Cleo fades back into sleep and the family takes shifts watching. According to "Gone from My Sight" by Barbara Karnes, which outlines the stages of death that was provided by hospice to the family, patients experience a surge of energy to establish closure and the family knew those might have been their last words with Cleo.

Throughout the day, Louie Costa split his time between being with his wife, rubbing her feet and comforting her, and other menial tasks to keep his mind active. He began to work on the finances, traditionally Cleo's job.

He went through his address book, checking numbers and calling old friends to update them. With each call he was able to say hello, but couldn't bring himself to talk about his wife. He handed the phone to his children to relay the details.

"I can't, I just can't do it."

He absent-mindedly fiddled with the two rings on his left hand. One copper, designed to prevent his knuckles from swelling, the other gold.

"They took it off her when she went into the hospital and I put it here on my finger and here it's going to stay," he said.

Friday night, July 20, Cleo was restless and refused her pain medication. When she finally calmed down, the children dispersed to let her sleep. Early Saturday morning, Gwen Costa awakened and decided to sit with her mother-in-law for a few minutes.

Just before 3:30 a.m. Saturday, with her daughter-in-law stroking her hand and just short of a week after coming home, Cleo died.

•••

As the lights dimmed and the voice of Nat King Cole filled the chapel, Louie Costa reached for the hand of his daughter.

"It's OK dad," Costa-Landers said, "These are the good times. The good memories."

The service was attended by some family and close friends, several of whom spoke during the gathering.

Thompson recalled memories of joy about her mom, including her attempt to ride a skateboard and dealing with replacing the wallpaper in the kitchen.

"In our family, there was no doubt that mom loved you," Thompson said.

It's not a funeral service, but a celebration of life, Cleo's life.

After the service, the family gathered at the Carson City Elks Lodge for lunch and to share stories about Cleo. Surrounded by friends, Louie, who said he enjoys the occasional drink, sipped from his glass of Corval Brandy.

It was his first drink since his wife became ill.

Slowly, friends and extended family began to offer their last condolences and head home, leaving only the family.

Later that night, Costa-Landers decided to watch the DVD one more time. As the music started, the week of waiting and making sure everything was taken care of slipped away. She let herself cry.

"We have one hundred thousand good-time memories of her. So because we have those and because of her love, to me she will never die."

Things to think about when dealing with death

General preparations

• Discuss wishes and level of care wanted in event of accident or illness

• Collect personal information and a photograph for an obituary, including choosing where donations and flowers should be sent

• Decide what should remain with the body and what should be given to others, including clothing, medals and jewelry

• Choose a funeral home

• Make sure information about insurance, investments and finances can be found by others.

Funeral home preparations

• Choose casket or urn, location, type of service and who will perform it

• Select music, floral arrangements, scripture to be read, memorial register and visitation and viewing options

• Select officiator, decide on eulogy and pallbearers, if appropriate

Final arrangements after death

• Arrange for transfer of the body to the funeral home

• Apply for death certificate

• Set final time and date for service

• Submit obituary

• Contact reporter Jarid Shipley at jshipley@nevadaappeal.com or 881-1217.