The Big C and Me

Editor’s Note: This is an excerpt from the book “Reflections for the Future” that includes many of my dad’s writings (e-shrink). You can order it on lulu.com (hard back) or download the pdf of the book for free. Dad referred to this article in a recent blog post so I’ve copied it here.

They faxed the results of my CT scan the other day, and it showed no signs of reoccurrence. Briefly I felt a sigh of relief, such as I imagine the men on death row must feel when they get a reprieve to delay their execution. This journey began nearly a year ago, only a few weeks after my brother died of a rapidly progressing lung cancer. Fortunately, he had little time to suffer as he died only three weeks after he was diagnosed. My wife insisted that I should have a chest x-ray, and there it was, “a right upper lobe mass.” My hopes that it might be a benign lesion were dashed when the follow-up scan was interpreted as “Probable bronchiogenic carcinoma” and confirmed when the PET scan “lit up.”

One would think that my training and research interests would have prepared my to deal with this problem, for back when I was an academic my colleagues and students jokingly referred to me as the “Angel of Death.” This was due to my interest in thanatology (death and dying). At least on a conscious level I was interested in how awareness of our mortality affected such things as personality, super ego development, motivation, mood problems, suicidal and other self destructive behaviors. I now wonder if much of my interest had more to do with my own personal conflicts than a strictly scientific interest. My research led me to the believe among other things that Freud was correct when he stated that people generally were unable to imagine their own non-existence. He was also quoted as having said while he was dying of a painful malignancy that he envied those who believed in an afterlife. Billy Graham seems to have something in common with the Islamic suicide bombers in that he has said that he is looking forward to death for he is convinced that he will have another one much better than his current one. I have also seen many patients who yearn for or even attempt to hasten their death in order to rid themselves of unbearable physical or emotional pain. For some my studies seemed to indicate that there may even be a sexual component to their fantasies of death, and for others a reunion with loved ones who have “gone before’. These are attitudes which I labeled as thanatophilic.

Unfortunately, I am not a thanatophile, On the contrary I am quite thanatophobic, I love my life and as is the case with most things, with the threat of its loss it becomes more precious. My education in the sciences has given me an appreciation for the awesome complexities of life, and some understanding of its fragility, but it is more than the sum of its parts. Now more than ever I look out our kitchen window and marvel at the birds as they all struggle to sustain their life and are programmed to replace themselves so that “life goes on”. I am overwhelmed with their beauty and grace. Is life just a complicated chemical process or does it house something spiritual? I am certainly not the first person to pose that question. When I attempt to understand the physicists as they theorize about the nature of matter and the vastness of the universe, it seems my life must be very insignificant; however sometimes I act as if the world could not get along without me. I guess Freud really was right in that I can’t imagine myself as being dead.

When I first received the shocking news that I had cancer, it suddenly became very clear that my musings and “scientific” investigations into how people think about and cope with death were of little use to me. Kubler-Ross was a researcher at University of Chicago who had beaten me to the punch with her book on death and dying; consequently I had always criticized her for what I considered an overly simplistic explanation of the dying process. Much to my chagrin I found myself to be a poster boy in following her descriptions of people’s behaviors as they faced death. The 1st stage she described was one of grief, and I did that one well all the while attempting to hide it out of a sense of embarrassment. Initially I tried to regain control by trying to “get my affairs in order”, but that rapidly gave way to a feeling of intense sadness which was most severe when I thought of my Grandchildren. I found myself suppressing tears whenever I thought of them. I told myself this was ridiculous, for how could I anticipate feeling this sense of loss if I were dead. If I were dead I wouldn’t feel anything or would I?

It has been said that ignorance is bliss, and also that a little bit of knowledge is dangerous. I knew my body had betrayed me and that my own cells were attempting to destroy my vital organs. I could picture them as they would look through a microscope with their bizarrely shaped nuclei, many of them in the process of dividing as they rapidly reproduced themselves. I knew the traitors had spent the last several years quietly multiplying in my lung preparing for the final assault. The obvious defense against this army was to totally destroy them, and this could be accomplished only with surgery. There would be collateral damage of course, but pulmonary function studies indicated that my body could survive the loss of a lobe (approximately ½ of my right lung). Barb made me promise to “fight like hell” and I vowed to do just that; however as the day of surgery came closer I became more fearful. My fear was that I would wake up attached to a ventilator with my arms restrained and unable to speak, or of some other complication ( I could think of many) that would render me helpless. The idea of such helplessness had always been terrifying to me. The ultimate horror I could think of was quadriplegia with right sided stroke a close second. It turned out those fears were groundless and I tolerated the surgery well for an old bugger. The epidural almost completely eliminated the post operative pain for the first few days, and other than being tethered to a couple of garden hoses protruding from my chest wall I was reasonably comfortable, after Barb had raised enough hell to get me a more comfortable bed than the slab on which they initially placed me.

The pathology report was favorable with no tumor cells found in the lymph nodes ( the most likely route through which the they could spread) and although the tumor involved the visceral pleura ( the covering of the lung) it did not appear to have penetrated into the pleural cavity. This invasion of the pleural cavity is what had killed my brother. The five year survival rate with this type and stage of lung cancer is sixty seven percent. I am told that this could be improved by seven more percent with chemotherapy: however the side effects from the extremely toxic drugs designed to kill those little devils that might have escaped can also do serious damage to healthy parts of my body. I decided to take my chances without it.

My spouse who has been a cancer survivor for twenty years has been a rock, and we have rather deftly switched roles with me now dependent on her for support. She acknowledges my fears, discourages my somaticising, and encourages me to live in the here and now. I have gone through Kubler- Ross’s “bargaining stage”. In my case this involved pleading with God to allow me to stay here to see my grandchildren grow up. I have been amazed at the number of people who knowing of my illness say they are praying for me. This includes friends, casual acquaintances, and even patients all of whom seem to know of my ordeal. I have decided that with all of the problems facing God it is presumptuous for me to expect special treatment, so I have decided to keep my eye on the ball and do what I can to follow his will as I imagine it to be. I hope to stick all these death and dying fears back in some corner of my mind. It has been my experience that one of the major problems with worrying is that we usually worry about the wrong things and the bad things that happen to us are the ones of which we never thought. The fact that I don’t want to die is a testament to how fortunate I have been to have such a wonderful life. Maybe my luck will hold and I will die in my sleep in another twenty or thirty years.