Facing Mortality
Sunday, May 1, 2011 at 02:53PM 
“It is difficult to think of dying consciously when we notice how incomplete we feel, how frightened we are of life. It is almost as though we were never completely born, so much of ourselves is suppressed and compacted just beneath the surface. So much postponed.”
—Stephen Levine, Who Dies?
By Tom deMers
Hank appeared at my door looking exhausted. He was unusually thin. A few months earlier he’d had a tumor removed. He spent the weeks between then and now pursuing treatment, but not the chemotherapy his doctor advised. Instead he chose to go after a worsening of his longtime digestive problems, which now included diarrhea. It was a few days before Christmas when Hank showed up. Although he was Jewish, I’d often sent him a Christmas present. I hugged him and told him he was our baby Jesus. He also had a gift for us although it wasn’t evident at the time. Two months later and two months before his 66th birthday, Hank died.
People die every day. Many thousands died a few months ago in the Japanese tsunami. But when someone really close to you dies, someone you have hiked with, eaten dinner and talked late into the night with, someone whose company you greatly enjoy, that’s different. It’s your own death then, as close as it gets without taking you out, as close as that semi you nearly turned left in front of when you weren’t paying attention.
So you pay attention. You wonder what Hank could have done differently, not just regarding his more recent problems but what corrections he might have made years ago. You question quirks and behaviors you once accepted as being “just Hank.” You start to ask inappropriate questions, not out loud perhaps, but you wonder. How could this be happening to a man who was so health conscious? How did it take root? Why wasn’t it caught earlier? And as you probe his life, you realize you are probing your own.
Several contradictions were evident. Hank was a vegetarian who ate moderately and did no more than sip alcohol. He was a thoughtful person and conscientious in his personal life. A recently published book names conscientiousness as the best childhood predictor of longevity, “the qualities of a prudent, persistent, well organized person” (Friedman and Martin, “The Longevity Project”). Those qualities fit Hank. The same book says the best enhancement of longevity is improved social relations. Hank loved people, had many friends and a gift for calling forth the best in others. He was a team player with a hospital lab in Jos, Nigeria named for him. How did such a person allow a mass of rogue cells to spread through his intestinal area?
Some facts were clear. There had been a misdiagnosis the previous March when Hank went to his doctor with a lump in his lower right abdominal area. His physician told him it would pass. It grew larger. In July the doctor ordered a colonoscopy. It revealed a sizable tumor. Surgery quickly followed. A big section of his colon was now gone, but chemotherapy was ordered in case some cancer remained. There was hope at this point, but also a problem—serious diarrhea, continuous and painful. Hank started the chemo regimen, then stopped it to deal with the diarrhea; the chemo plus diarrhea were overwhelming. His oncologist discouraged this course, but Hank pursued it, staying with friends and trying various remedies for months, including an alternative Utah clinic that cost $10,000 a week. After several weeks with little change, the clinic ordered a PET scan that revealed more cancer. That was when Hank came to Colorado where his new primary care doc made a counterintuitive suggestion—stool softeners. She reasoned that softeners retain water and might be helpful. Two days after following her advice, Hank was back to normal. The healing he’d sought for months was achieved.
His spirits soared. Another colonoscopy proved normal. Chemo was ordered to begin on Monday. Friday night my wife and I celebrated with him at a movie, watching “The King’s Speech.” We were out the next night when a distressed Hank called. He felt terrible. Could we drive him to the hospital? We took him to the ER where they asked a lot of questions before they pumped his stomach. The answers came after a CAT scan: a tumor was blocking his small intestine (invisible to the colonoscopy). Until it was removed, chemo was out of the question. The next day he learned the tumor was inoperable.
Two weeks before Hank died, 18 of his best friends gathered in our living room. It was a circle of love and appreciation that temporarily obscured what most of us felt was a tragedy. For me, the many questions resolved to this: How had a smart, conscientious and detail-oriented guy allowed this cancer to get past his radar? What was Hank’s blind spot? One friend asked a deeper question: Since we all carry the potential for cancer, what triggered the abnormal cell growth that led to a tumor? The most intriguing answer came from one college friend. Hank’s relationship with his dad, a gifted but perfectionistic artist, had been contentious. The friend suggested that the father had found the son unacceptable and may have rejected Hank when he did not “measure up” to his stern requirements. For me this fit with many aspects of Hank that I’d noticed: his old and somewhat drab clothing choices, his discomfort with anger, his parsimonious lifestyle, elements that pointed to a sense of unworthiness, to the paradox that Hank seemed to value others more than he valued himself.
Was this the cancer’s source, a gut-level rejection of himself as having value? Or am I imposing meaning on a situation I need to understand? Is my “diagnosis” of him actually an analysis of myself? For as we questioned, one thing became clear: we were not only talking about Hank. His death illuminated our own, the tests we were avoiding, the chest pain we ignored, the chinks in our medical armor, our blind spots.
Hank’s gift was his courage in those last weeks, and helping us see ourselves in those uncomfortable questions.
Tom deMers, cancer, friendship, healthcare, mortality in Opinion
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