LOGAN, Ohio (AP) — A dispute over whether a terminally ill woman should have been given tea and toast or an orange apparently upset her husband so much that he shot and killed two of the woman’s sisters and his own son before killing himself, a sheriff said Tuesday.

The sick woman, Darlene Gilkey, witnessed the shootings from a hospital bed in her living room but wasn’t hurt, Hocking County Sheriff Lanny North said. The 59-year-old is dying of cancer, he said.

The woman’s son, Ralph Sowers III, told a 911 dispatcher he survived because his stepfather, Paul Gilkey, said he was sparing him because he had kids.

After the shootings Monday, 63-year-old Paul Gilkey stepped out onto his front porch, sat down in a chair and shot himself to death, the sheriff said.

Killed inside the home were Darlene Gilkey’s sisters, Barbara Mohler, 70, of New Straitsville, and Dorothy Cherry, 63, of New Plymouth. Also killed was Paul Gilkey’s son, Leroy Gilkey, 38, of Columbus.

North said events leading to the shootings began earlier in the day when some of the victims had apparently served Darlene Gilkey tea and toast after Paul Gilkey had already peeled an orange for her.

That led to an argument that escalated over time and culminated in the shootings, the sheriff said.

“It sounds like it was over her well-being, her care,” the sheriff said.

Paul Gilkey, who went by David, served a decade in prison beginning in 1974 for killing a man in Athens County in May of that year, according to court records.