Two nights after his death, the scene at Dr. James Nishio’s home was oddly comforting in its familiarity. The Republican debate raged on a 60-inch television. Piles of Mexican food and bottles of wine crowded a kitchen counter. One of his sons lay on a couch, recovering from reconstructive knee surgery. His wife, Dr. Denyse Nishio, perused emails while friends and relatives reminisced, at one point busting loose with an off-key rendition of an old Linda Rondstadt classic.
But the chair was empty. For the past three years, Jim’s home inside his home – a wheelchair with straps and tubes and a robotic voice-assisted computer – was positioned smack in the middle of the living room. Now it rested up against a stairway, idle, no longer of use.
And isn’t this just like life? No one saw this coming. A brain tumor.
Jim Nishio, a prominent critical care and pulmonary specialist, had battled ALS for almost nine years, far exceeding the average life expectancy. He succumbed instead to a sneak attack, a mere two weeks after being diagnosed with a rapidly progressing cancer.
“I’ve never seen anything like this,” said Dr. Greg Redmond, who was Jim’s primary care physician for more than 20 years. “To get ALS and then to get brain cancer? Only about 10 percent of ALS patients survive 10 years, but there is no doubt in my mind that if Jim had not developed the tumor, he would have lived much longer than that. He was in a very stable period the last few years.”
The science regarding amyotrophic lateral sclerosis – commonly known as Lou Gehrig’s disease – is a chronic study in futility. Seventy-five years after Gehrig’s emotional farewell at Yankee Stadium, there is no known cause. And no known cure. An estimated 30,000 Americans suffer from the illness that causes muscle weakness, paralysis and, ultimately, respiratory failure.
Awareness and funding have increased with events sponsored by Major League Baseball and the Ice Bucket Challenge that went viral in 2012. Thousands participate in the annual ALS Walks held throughout the country. Since Jim’s diagnosis in 2006, dozens of relatives, colleagues, friends and caregivers have tugged on their “Wish for Nish” T-shirts and participated in the Sacramento event that begins and ends at Raley Field. In his later years, Jim tooled along the route in his power-operated wheelchair, his loved ones guiding him around potholes and cracks in the sidewalk.
The Nishios will attend this year’s walk again en masse – next Saturday, Oct. 3 – with particularly heavy hearts. Still no cure. And now no Jim. Though he didn’t live long enough to benefit from any medical breakthrough, and lost several of his own patients to ALS, his legacy is uniquely Californian, a tragedy, mystery and love story compressed into 67 years.
Jim Nishio loved family, sports and politics, in that order. He was born in Fresno to parents who endured hardships during World War II. George Nishio, an optometrist, was sent to relocation camps in Arkansas and Tule Lake in 1942. Michiko, who later became a public school administrator, moved with friends to the Midwest to avoid internment.
After the war, the couple married and settled in Chowchilla, where they raised six children, among them an optometrist, plant physiologist, elementary school teacher, entrepreneur and administrator with the Franchise Tax Board. Jim, the eldest, was both a scholar and the best athlete of the bunch, a ferocious competitor and football, basketball and baseball standout at Chowchilla High. A chance meeting with Fresno minor-league pitcher Masanori Murakami, the Giants prospect who would became the first Japanese player in Major League Baseball in 1964, caused him to switch allegiance from boyhood idol Mickey Mantle to anyone wearing a Giants uniform.
“I was a big Yankees fan,” Jim confessed while attending ALS festivities at a Giants game in 2009, “but (laugh) of course I still love Lou Gehrig.”
His one regret, he often said, was declining an offer to play centerfield at UC Davis so he could concentrate on his pre-med studies. But his pursuit of sports and near-obsession with physical fitness remained constant companions as he earned his medical degree at UCSF, completed his residency at the University of Michigan, and began practicing in Sacramento. Any spare time was devoted to running, skiing, or pickup basketball and softball games. Shortly before his ALS diagnosis, he was transitioning into mountain biking.
“He was such a great athlete,” said his son Grant with a wry grin, “that none of us could beat him at anything. When I made The Bee’s all-city soccer team at Jesuit, I finally got a chance to say, ‘Gotcha, Dad!’ But he was always my hero. He was a great father, great doctor. He was good at everything.”
Jim met his wife, the former Denyse Fox, while both were doing their residencies in Ann Arbor. They moved to Sacramento in 1980, where Denyse began practicing internal medicine at UC Davis and Jim became a partner in Pulmonary Medicine Associates. He also served as medical director of Sutter General ICU and chief of staff at Methodist Hospital, and was the area’s first certified sleep disorder specialist.
“Jim’s passion was critical care medicine,” said Dr. Alan Cubre, a partner at Pulmonary Medicine Associates and friend of the Nishios since Ann Arbor. “I don’t how he was able to do this, but he was ICU director at Sutter until 2004 and Methodist until 2006. It’s just very unusual to run two ICUs at one time.”
Colleagues said Jim began noticing symptoms around December 2006. “Jim approached one of our other partners, Tom Shragg, one day when he was unable to open a jar,” recalled Cubre. “He showed Tom his hand, and the muscles were twitching. He asked, ‘What do you think that means?’ Tom told him, ‘You and I both know what that means.’
“It was very difficult because, as pulmonologists, we see patients with ALS, and we all know what was going to happen.”
Almost four years after the diagnosis, as his dexterity deteriorated and he was no longer able to perform procedures, Jim retired from his practice but was determined to remain active. The family took vacations to Europe, China, Alaska and Australia. And as Denyse likes to say, her husband was a man for all seasons; if one of his favorite teams or any of his four adult children were playing soccer, baseball or competing in gymnastics during college, she often packed the medical equipment into the van and off they drove.
Jim’s love of sports was contagious, though admittedly for Denyse, an acquired taste. The Wolverines’ fight song was the family anthem. A Giants World Series banner hung above the fireplace. At night, everyone gathered in front of the massive TV that often incited Jim’s wrath; while he still had use of his hands, he was known to toss a sock at the screen when the Giants were getting beat, the Wolverines were outclassed or the Kings were losing to the Lakers.
A longtime Kings season-ticket holder before his illness, he once asked if DeMarcus Cousins was a winner or not worth the trouble. I urged patience. He smiled.
“I always dreaded coming home and there weren’t any games on,” Denyse said half-jokingly, “because that meant we had to watch ‘Wheel of Fortune’ or ‘Huell Howser’ replays. I mean, he (the late Howser) didn’t take you to Paris, London or Cairo. He took you to Joshua Tree or the Fresno State Fair. But that was Jim. He was a California boy.”
But far from a one-dimensional man. Word games were a hobby, as were politics. Jim relished heated debates, and even in his final weeks, emailed his sharp opinions. As the ALS progressed, he cherished milestones that included the college graduations of all his children; the marriage of his oldest son, Grant, to Jennifer Avrin, who grew up a few houses down the street; his daughter Lesley’s first year of medical school; and the professional accomplishments of his other sons, Garrett and Ross.
He showed Tom his hand, and the muscles were twitching. He asked, ‘What do you think that means?’ Tom told him, ‘You and I both know what that means.’
Dr. Alan Cubre, Jim Nishio’s friend and former partner
In his final years, he required the near-full-time assistance of two health caregivers. Family members discreetly sliced food into tiny bits. His sister, Nancy Nishio Mah, arrived every Monday with home-cooked meals, eventually limited to a small choice of soups and broths. Denyse bought a sleep-number bed and spent every night at his side.
When robbed of his mobility, he adjusted to life in a power-operated chair, his arms and neck fastened. When he lost his voice and required a feeding tube, he mastered a speech-generating computer controlled by his retina. When his respiration failed, he made the wrenching, life-extending decision to accept a ventilator.
“Some ALS patients who start failing decide they don’t want to live,” said Redmond, “yet here was someone who had patients on ventilators, who was a critical care specialist, who had a tremendous will to live. While we can’t prove it scientifically, the love and support of Denyse, his kids, and his siblings, cannot be understated. That, and the fact he loved sports so much and took such good care of himself prolonged his life. He had a perfect mind in a paralyzed body.”
Until the brain cancer. In his final weeks, he became increasingly confused and visibly frustrated by the sudden inability to communicate. When the tumor was discovered in late August, he declined radiation treatments that might have extended his life by a few months. Instead, he gathered his loved ones and told them it was time to move on. He urged Lesley to return to medical school and counseled the boys to tend to their careers. He thanked his siblings for their unwavering support. He told Denyse he loved her. And then that last night, after the ventilator was removed, Jim Nishio died quietly and peacefully.
“He was ready,” said Denyse, “and in a strange way, he was glad that it wasn’t the ALS that beat him. He fought the good fight, fought longer than anyone expected.”
In a quiet moment after the ventilator had been removed and her husband had passed, she forced a slight smile. There was a final story to share: Two days before Jim was rushed to the emergency room and the brain tumor detected, several family members were riding to a Giants game when their SUV blew a tire just outside Dixon. While everyone waited for AAA to arrive, grumbling about missing the first few innings, Jim was noticeably patient.
“It was the strangest thing,” Denyse said, softly. “The way he was looking at the familiar surroundings, at all the farmland, soaking it all in. I just had this thought. I wonder if he’s thinking, ‘This is the last time I’m going to see this. And I love this country.’ It was as if he knew.”