How smoking killed my father

We discovered the meaning of "terminal restlessness" the hard way. That much-feared phone call, the one that many have taken before us and many more are yet to receive, came at 4.30am on June 17, 2007.

My father was dying. He was suffering "terminal restlessness"— his entire body was flailing helplessly, his arms struggling uncontrollably, pushing against something to simply get himself somewhere else. He was fighting a battle he could not win.

For the medical staff who cared so genuinely for him during his stay at Glengarry Hospital in Perth's northern suburbs, the restlessness signalled Dad's last desperate grip on life.

As my heavily pregnant wife Emily and I rushed to his side, my dad was losing his 12-month battle with lung cancer. He was just 52 — far too young.

Barely 12 hours earlier, Larry Liew, who runs the palliative care unit, broke the devastating news that Dad's death was imminent. He was direct, refreshingly so.

Speaking to Dad through his semi-conscious haze, Dr Liew told him there was nothing medical science could do to assist him with his battle any more.

"Now is the time for you to make your peace, Neil," he said. "It's been a pleasure and an honour treating you. We will do everything we can to make you comfortable, but you will not survive this. It's time to make your peace and say the things you need to say to the people around you. You have to do this for them Neil, and you have to do this for you."

I started writing this in the days following Dad's funeral, on June 27. I finished it on the first anniversary of his death.

I watched my son, born a month after Dad died, as he took his first tentative steps, and talked in his unique baby language, and I know how much Dad would have loved to have held him, even just once. I miss him, and I know I'm not alone on that score. I also know there are many more tears to fall.

I know my dad wanted me to write this story — he told me so before his death. He described it as a story of one family's struggle, and I write this in the hope that just one person will heed his dying warning: smoking kills.

Dad's story started on May 12, 1955. He was the youngest of five brothers to my grandparents Ron and Marge Eliot.

His childhood was that of a typical Scarborough lad — sun-soaked days surfing at the beach, booting the old pigskin at the local park, cracking a cricket ball in the nets with his mates, and — both sadly and fatefully — puffing away at cigarettes behind the school bike shed. Girls, mates and mischief.

He stumbled into becoming a press photographer. But during a career spanning almost 40 years he earned the mantle of one of Australia's most highly decorated snappers. He won dozens of awards, including the highly coveted Walkley Award.

Dad's embracing nature was reflected by the massive turnout at his funeral, with up to 600 mourners packing the chapel and queuing outside at the Pinnaroo Valley Memorial Park. We played a slide show of some of his greatest pictures at the service, which reminded everyone of his talent.

During the slide show, we played the Augie March song, One Crowded Hour, a tribute to fallen cameraman Neil Davis who lost his life in Thailand filming a street battle.

As I delivered a eulogy, I focused on a brick in the back wall. I knew that had I made eye contact with the audience, I would have faltered. Badly. I got through it. Just.

Funerals are, of course, a celebration of a person's life. Much of the commentary, naturally, painted my old man as a great bloke, a terrific mate and an accomplished professional. But of course Dad had his flaws. There's only one that I am compelled to write about — his addiction to smoking, an addiction that proved fatal.

He was a pack-a-day smoker from his late teens until his late-30s when he quit for eight years and then fired up again in the pressure-cooker environment of the Sydney Olympics. At the end of my eulogy, I reminded the congregation, "Make no mistake, it was smoking that killed my father".

You could have heard a pin drop.

It was June 2006 when the alarm bells first starting ringing about Dad's health. At the time, my wife and I were shaking and shimmying our way across the Kimberley's famous Gibb River Road. Dad waited until we returned before breaking the news to us. He broke down as he told me that he had to see me. "I'm sick," he said. "I need to see you."

I arrived at Dad's Maylands home in my unpacked four-wheel-drive. I faced him wearing my red dust- covered clothes and sporting a four-week beard, as he told me he may have cancer. I put on a brave face — telling him we'd all pull through it together, promising him he would not fight alone.

By late June Dad was diagnosed with small-cell lung cancer — an aggressive form that Mount Hospital oncologist Dr Guy van Hazel told us was primarily caused by smoking.

The scans revealed three tumours in his right lung, the largest being 4cm. We were told this form of cancer had become less common because it was primarily caused by smoking, and smoking had declined in popularity as researchers found further links to all manner of nasty health conditions. The chance of Dad going into remission was strong, we were told, but there was an equally strong chance the beast would return. Google told us Dad was unlikely to live five years.

His treatment was to consist of three consecutive days of chemotherapy every three weeks. The first day was torturous — the nurses would first flush him with intravenous saline, then load him up with anti-nausea drugs, then start on the actual cancer-killing drugs, cisplatin and etoposide.

Dad would shuffle into the hospital for his chemotherapy, have a cup of tea and a chat with the nurses before nodding off in a chair. He would wake, have an icy- pole to sooth the pain of the ulcers, and have another laugh with the nurses before shuffling out of the hospital, often lighting up another cigarette on the way. I would sit with him for the majority of the treatment, bringing him his cuppa, joining in the conversations with the nurses, watching as he slept and walking him to my car once he woke. My brother and Dad's mates were either en route to check on him or on the phone as he shuffled out to my car.

The first days after the treatment were the worst. Almost in slow motion, Dad would fall into a hole. A Silver Chain nurse later described the bottom of the barrel as the "nadir"— a reference to the low blood counts caused by chemotherapy, which, when roughly translated from Arabic, also means the direction towards your feet when you're standing — straight down. The treatment smashed his white blood cell count, making him susceptible to infection — a side-effect that so often proves deadly.

When we were lucky, Dad would bounce back after about a week, giving us two almost "normal" weeks to enjoy with him.

He lost all his hair, dropped from about 75kg to 52kg in the space of a week, and was hospitalised several times. By late November 2007, the disease was on the run and the cancer went into remission. His hair grew back, he became strong enough to resume his work and he quit smoking for the second time in his life. But a trip to the Eastern States in late February saw him back on the smokes and within weeks the cancer returned.

The second round of chemotherapy almost killed him, but it had little or no impact on that single, monstrous tumour that had, alarmingly, swelled to about 10cm. After a desperate race to hospital in late March, Dr van Hazel said a patient with small- cell lung cancer had less than a 40 per cent chance of going into remission during a second incidence.

Based on scans and Dad's unresponsiveness to the chemotherapy, his chances of going into remission a second time were even lower. He warned my brother and me that our father was unlikely to live another six months. We were standing at the reception desk of the ward when we received the news. Proving that ignorance truly can be bliss, Dad laughed with a mate in his room — totally unaware of the grave statistics — as my brother and I digested the news.

Dad remained positive despite his ailing health as my brother and I started planning for the worst. We had already organised Silver Chain. The charity organisation, staffed by people who truly have hearts of gold, ramped up their care on our request.

We organised a trip away, nothing extravagant, just a weekender in Busselton. We played cards and Scrabble, ate and drank too much and laughed at the simple things in life. By this stage, Dad was hooked up to an oxygen tank to make breathing easier as often as possible during the day.

One night, after he collapsed in the kitchen while boiling a kettle, we realised he posed a grave risk to himself. It seemed as though he was afraid that if he closed his eyes to fall asleep, he might never open them again.

We also arranged a stay at the Sandalwood Ward. The first three-week visit was all about stabilising Dad, who had formed a dangerous pattern of sleeplessness and was struggling to accurately measure his medication for the numerous side-effects of chemotherapy, most notably pain.

Nurses fondly remember him shuffling down the hallway with his swollen feet in oversized slippers to get himself another cuppa-soup or, incredibly, puff on another cigarette just minutes after receiving huge quantities of sedatives that should have been enough to put an elephant on its ear. He would amaze them with his old war stories — like the time he stayed in a Greek lighthouse, shopping in an exotic Turkish bazaar, or when he produced a front page picture of the stricken Greek oil tanker, the Kirki, as it floundered off the WA coast — an image that earned him the Walkley.

After almost three weeks, Dad's independent streak was fuelling a desire to leave the hospital and return to a more normal life in suburbia, despite advice to the contrary. The compromise was to live with my brother. During this period, Dad received the news we were expecting. He was told the chemotherapy was having little or no effect.

Dr van Hazel urged Dad to weigh up whether he would endure another round of chemotherapy for little or no benefit against the prospect of not having the treatment, improving his quality of life but almost certainly accelerating his death.

In a nutshell, Dad was weighing up quantity versus quality. In typical fighting fashion, he wanted to have another crack, although he wanted a few weeks to regain his strength before returning to the treatment. He knew the delay would allow the tumour time to grow. My brother and I had started warning people to prepare for the worst.

Many of his friends were shocked by his reply when asking about his health —"good as gold, mate". He clearly wasn't. One of his close mates quietly warned others to "wear their sunglasses" when visiting Dad so that he would not have to see the tears welling in their heartbroken eyes.

The beginning of Dad's end started on a Friday morning. My brother and I had been unable to reach him on the phone, so I ducked out to check on him at his house. There's no way to sugar-coat his appearance on that morning. By this stage, his tumour was so big it forced him into a stoop despite his attempts to stand upright. He was all over the place. He was slipping in and out of consciousness. He would feverishly move around the house, making another cup of tea, grabbing another icy-pole, lighting another cigarette, swilling another energy drink. He had fear in his eyes.

The Sandalwood Ward had room for Dad. Two nurses helped me get him out of my car and rushed him to a room where his vital statistics were dangerously low.

The lungs that Dad had so badly damaged through smoking were struggling to get enough oxygen to his body. His heart was exhausted from trying to supply his body with oxygen that simply wasn't coming from his lungs.

Dad slipped into unconsciousness again as the nursing staff administered a host of fluids, including antibiotics and blood transfusions. By Saturday afternoon we had the news that Dad would not make it. This is the part the smoking advertisements don't tell their customers about.

Dad said his goodbyes. He told my brother and me he was so very proud of us. He held his best mates' hands, told them he loved them. He hugged one brother, and spoke of promises of 40 virgins "on the other side" with another who was living in Geraldton.

He thanked my stepdad for bringing so much joy to my mum's life. He told his mother he loved her, no doubt hating the fact he was about to become the third son she had lost, with her grief compounded by the recent death of her devoted husband — my grandad.

He put his hand on my pregnant wife's belly, probably about where his unborn grandson James' feet were, and apologised. "I'm sorry Em," he told my wife, with simple words that still burn in my mind. "I'm not going to make it."

The restlessness came less than 12 hours later. My brother, I, and our wives never left his side until the end. He was not expected to live through that Sunday.

Dad was receiving regular doses of painkillers to manage the pain, and sedatives to calm him as he approached death. We would attend to his every need.

At one stage, through laboured breaths, he managed to tell us he was struggling for something we simply could not provide. "I . . . need . . . air," he said. "I . . . can't . . . breath."

Although talking was near impossible for Dad, he did manage to tell us he loved us.

By the Wednesday, the struggling was less frequent. He simply slept, with us by his side. At one stage he started taking his last breaths, before, in a final act of defiance, he took three enormous gulps of air and kept charging on as though nothing had happened.

Then, shortly after midnight on June 20, as the nurses rolled Dad on to his side, he took his last, laboured breaths, surrounded by his family and loved ones.

My family and I are not the first to lose someone. We won't be the last. But as much as I can accept the realities of life, I just cannot accept an unnecessary death.

My dad was 52. His first grandson was born just 32 days after his death.

"He didn't need to die. Smoking is dirty and it kills."

_* Neil Eliot was a Walkley Award-winning WA photographer who spent many years of his career at The West Australian. Luke is a journalist at The West Australian._