A Knight in Tattered Armor

Mickey's Bagel Bistro, Juneau Alaska
Mickey took great ride in his bagel stand, and
always thought of it was one of his finest achievements.

My older brother Mickey Pico died Sunday May 12 around 5 am while in hospice care at the Sutter Medical Center in Santa Rosa, 15 years after he was diagnosed with hepatitis C, less than a year after the doctors discovered he had liver cancer. He was 65 years old. His funeral will be Thursday, May 16, at 10 am, in the Garden of Tranquility at Oakmont Memorial Cemetery, 2099 Reliez Valley Road in Lafayette.  He is survived by his 12 year-old daughter Sasha, and his estranged wife Joni.

Mickey was never a home owner.  He loved to take road trips, and his belongings are scattered at friends' houses up and down the Pacific coast, where he deposited them over the past year.

The way Mickey lived his life is actually part of a Pico family tradition, exemplified by our dad, Charlie Pico, whose grave is just a few feet from where Mickey will be buried.

Similar to his dad, Mickey was a street vendor, and ran a popular bagel stand in Juneau Alaska for many years.  His appearance was striking.  He often would shave his head to show empathy for friends and family members going through chemotherapy and favored Bermuda shorts.  A different look that gave a message that went something like "The most important thing is to tune-in to the pain of others. You can always find a way to survive, and do that while conceding very little to convention."

Survive he did.  Mickey always had a job, but sometimes his living arrangements were Spartan.  There were times in Alaska -- Alaska! -- when he actually slept in storage space he rented, using the YMCA for a bathroom and shower.  The family thought in some ways that he was trying saying he could be as resilient as dad, and we got the point: Mickey was tough.

They were also similar in their generous spirits. One thing that everyone noticed about Mickey was that he never ignored a pan-handler, and he always gave them paper, not coins.

Mickey and Joni's marriage floundered after he was diagnosed with hepatitis C.  They separated, and Mickey started to put energy into taking care of mom.  It turned out that he had many qualities of an excellent caregiver.  He was always patient and accepting. while encouraging mom to try to do as much as possible for herself.  Best of all, he really loved her, and always gave her the sense that caring for her was exactly what he wanted to do with his life.

This arrangement was hard to maintain after mom became too sick to stay in her home.  Mickey slept on the floor beside her bed in the hospital, so she wouldn't be scared and alone if she woke up in the middle of the night. The result was back pain so severe he needed to be hospitalized at John Muir.  While he was there, he told a social worker he had not been getting enough to eat.  That was not something he shared with anybody in the family; I just found out when Sutter asked John Muir for his medical records.

Esther died in February 2012.  Mickey and I were co-trustees of her trust, and Mickey had the task of preparing the family house for sale. He did a good job and we ended up getting a good price.  Afterwards, Mickey immediately set about spending his share of the proceeds according to his principles, without consulting anyone.  He bought a gravestone for mom, and memorial plaques for her and her sister Lillian at Temple Isaiah.  He made a contribution to the Bay Area Brain Tumor Walk in honor of my wife Jean.  He gave a few thousand each to two women who had provided care and companionship for Esther.  He made a 40K undocumented cash loan to a woman he used to work with at Costco whom he felt sorry for because she was a breast cancer survivor..  By January of this year he had spent his inheritance.  Joni and Sasha were not entirely pleased.

But they were still the two people closest to him, and this April he decided he would drive down from Juneau to spend Mothers Day with them in Champagne, Illinois. He came through the Bay Area on his way, to check-in with family here.  On Friday, April 19 we had lunch together in Concord.  We had a pleasant chat, and although his voice was a bit faint he did not seem noticeable worse than before.  He told me he would be staying a few days at the Motel 6 before heading east.

On Friday May 3 Joni called to say Mickey was in the Sutter Medical Center in Santa Rosa, after being found walking around dazed near his car following a minor accident.  She and Sasha flew out to California on Sunday, and the three of us drove up to visit Mickey.  He was in the ICU, mostly unresponsive, but occasionally becoming agitated, pulling on his restraints and yelling "Let me out of here."  However, he became aware of Sasha's presence after she was in the room with him for a few hours, looked at her with recognition, and told his daughter that he loved her.

The Sutter doctors found that Mickey's liver function was almost completely gone, and as a result his kidneys had collapsed.  They were never entirely sure why his mental state had deteriorated. One theory was that it could be related to a possible stomach infection, and he was given antibiotics until the bacterial cultures came back negative.  Another was that it was caused by a buildup of protein bodies, a long-standing problem for which he took lactulose. Those protein body levels were high when Mickey entered the hospital, but he was no more alert after they administered lactulose and brought them down within normal range.  With those theories shot down, they decided that his mental condition was part of the systemic failure caused by the progression of his cancer.

In January Mickey had signed advanced directives saying he did not want to be resuscitated, that he wanted "comfort care" if the doctors decided that he was approaching the end.  Once antibiotics and lactulose proved ineffective, Sutter switched to comfort care, and he was disconnected from all his IVs.  If you've never seen anyone terminally ill, this approach can seem anything but comfortable.  It meant that Mickey received no fluids and nutrition, which according to common sense seems cruel.  But he was not dehydrated, fluids were accumulating in his extremities, and they could not feed him for fear that he would aspirate.  The major medication he received in his last days was morphine, to make his breathing easier.

On Saturday May 11 I cleaned out the Dodge Caravan that Mickey had been driving when he had his accident.  He had been sleeping in his car, not just at the Motel 6.  But he had been too proud to tell me about it, just like he wouldn't say he needed more food when he was caring for Esther at the hospital.  His last living circumstances had been harsh.

That evening in Mickey hospital room, one of the nurses brought Sasha a flute.  She gave us all a long concert while Joni and I sat in a meditative silence, and Mickey lay unresponsive.  Then Joni and Sasha went back to their hotel, and I sat and held Mickey's hand for several hours, telling him family news and appreciations that I doubt he understood.  Around 5 am two of the staff came to turn him on his back, and when I saw him open his eyes I started in again with what seemed to need to be said.  "Your vexing kid brother is here with you," I told him, "your beloved daughter Sasha has come to visit, and we all love you for being a free wheelin' travelin' man, crazy generous, living for principles, very, very good to mom."  I thought his eyes brows twitched, maybe this time it got through. Then he passed.  He had made it to Mothers Day.