Thoughts At Large

Passionate thoughts on random topics

Tag: death

Sharks and Cancer

quint

So, eleven hundred men went in the water, three hundred and sixteen men come out, the sharks took the rest…”  Quint, Jaws

It has been a very difficult year and a half. First, in November of 2014 my father died after a brief but excruciatingly painful fight with lung cancer which had spread to his bones. Almost one year later, last September, my wife died after a long fight with breast cancer which had spread to her lungs. And then only six months later, my dog died after a painful fight with a soft tissue cancer which had spread to his bones. One year, then only six months, part of me wonders what horror will befall us in three months. But I have to believe that the pain and suffering have ended now.  I can’t help but appropriate Quint’s quote to, “So, five of us went to Texas, three of us come home, cancer took the rest…”

Cancer has targeted my family for far too long now. I don’t want it to have any more power over us. My children have spent fully one-third of their lives living under the threat of cancer taking their mother and then their dog. Almost their entire teenage years, years difficult enough without cancer moving in to live with us, has been spent living under that dark cloud. They are 21 years old now and, in spite of these added pressures, will both graduate on-time from the University of Texas at Austin, each with over a 3.5 GPA. How they have been able to stay focused amazes me and is a testament to their strength of character.

I know people have had it harder than we have. I don’t claim to have a corner on suffering. And I am grateful for the seven years we were able to steal from cancer by moving to Texas and seeking treatment at the M.D. Anderson Cancer Center in Houston. I’ll never regret that decision. But if we could have a break from any additional pain for a short time, that would be great.

Each of us is dealing with these losses in our own individual manner. Certainly, grief counseling has helped, but we still face a world in which neither Lisa nor Delbow will walk with us any longer. We have had long discussions about faith, heaven, philosophy, and all of the accompanying topics. We disagree as much as we agree but the discussions are always lively and fascinating. I hope that we can each find some comfort in our positions.

Finally, there is the issue of moving forward. The house, already quiet from Lisa’s absence is now even quieter without Delbow’s rambling about. The kids are on spring break this week, so I have a respite before facing that still house alone. I now have six months of experience without Lisa and living alone. I hope this serves me well when the kids return to school. But before we know it, school will be over, graduations will have been concluded and we will be packing up for our trip back to Rhode Island. I hope it goes well and we can begin our new lives healthy. No sharks, no cancer.

Zerrissenheit

Shattered FutureGive sorrow words; the grief that does not speak                                                         Whispers the o’er-fraught heart and bids it break.                                                                              Shakespeare, Macbeth, IV, iii, 209

A very dear friend of mine gave me Anne Morrow Lindbergh’s book Gift from the Sea following my wife’s September 2nd death. It was a wonderful little book and contained a German word that accurately describes my emotional state: “zerrissenheit.” It is described as “torn-to-pieces-hood.”

The thing I am learning about grief is that it does not follow a linear path. One does not travel from one emotion to the next, leaving the first entirely contained in the rearview mirror. Rather, from minute to minute, I can wander from disbelief to acceptance to anger to sadness back to disbelief. This emotional whiplash takes a physical as well as an emotional toll. While I am back at work, my mind is not. This mental “zerrissenheit” manifests itself in a lack of confidence, second-guessing, a lack of focus, and sudden confusion. I was so much more confident when Lisa was here. I check my pockets a dozen times before leaving the house to make sure I have everything I need: keys, wallet, phone, etc.. In a word, I am lost.

And it isn’t that I don’t smile or laugh. I do. But so often I find myself reaching for my phone to text or call Lisa to tell her the joke only to realize that the call will never be completed again. I am having a hard time with the concepts of “never” and “forever.” I know that someday I will be glad for the time we had, but right now I am angry over the time that has been stolen (not to mention the time wasted fighting cancer when we should have been living our lives together). “Never” and “forever” are as daunting to me as the size of the universe is to a child.

It has been two weeks now, and the house is silent. I don’t know what the future holds anymore. We are taught to plan, to prepare as we enter adulthood. I did. This is not what I planned for; this is not the future I wanted. I am alone. My best friend was stolen from me. And while she would tell me to snap out of it and start living my life, this grief-triggered “zerrissenheit” is involuntary. I miss her so much.

No Autopilot When Spiraling In

spiral

As we continue our corkscrew toward the ground, we took another turn today. My wife can no longer easily swallow, causing her to cough when taking medications. Because she is so short of breath, she cannot cough up that which she has aspirated and she begins wheezing which results in her vomiting. Because she is not eating, the only thing she vomits is green bile from her stomach. It is a vicious circle as we spiral in.

The kids are convinced now that something will happen the day I drive them back to college. Given how we have tightened the spiral, I’m not sure I disagree.

Looking outward from inside this corkscrew is disorienting. As soon as I am convinced that something has settled, the wings tilt inward still further and we spin that much faster toward the ground. But one can find focus in this spin. When I least expect it and am most ill prepared, the gravity and magnitude of the situation (essentially the finality of it all) clubs me with a mighty blow after which I find myself gasping for breath, crying and floating directionless in the air until the reality of current circumstances force me to see the spinning and rapidly approaching ground through the windscreen.

There is no peace when spiraling in. Life’s obligations and daily tasks still require our attention: the dog needs to be fed and given his meds, the laundry never stops, groceries still need to shopped for, bills still need to be paid, work still needs to be done. However, there is a certain feeling of mechanization about it all. We go through the motions of shopping, eating, dressing, sleeping, as we have all summer, but there is no soul in it. Put your seats in the upright and locked position, return your tray table to its stowed position, tighten your seatbelt tight and low around your waist. The captain has exited the aircraft and will not be returning. Cancer is now piloting the aircraft. Thank you for flying the terminally ill skies.

The insanity of the situation is that all but one of us will survive the inevitable crash. We will survive but in what condition? And as hard as this flight has been, I cannot imagine how we will carry on after we bore into the ground. And it is approaching ever faster and filling my field of view. Unfortunately (or fortunately), I cannot see it clearly, because of the blinding rage and constant tears.

Stage Whiplash

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“There is not much sense in suffering, since drugs can be given for pain, itching, and other discomforts. The belief has long died that suffering here on earth will be rewarded in heaven. Suffering has lost its meaning.”                                                                                                                        Elisabeth Kübler-Ross

When Elisabeth Kübler-Ross wrote this in her groundbreaking 1969 book, On Death and Dying, she was, of course speaking of the patient, the person dying. In the book, she famously describes the “stages” the terminally ill patient goes through: Denial, Anger, Bargaining, Depression, Acceptance. The book was not meant to be considered a research study, a point she repeatedly makes. She also emphasizes that these stages may be skipped, occur concurrently or be returned to on the way to Acceptance. And yet we suffer. We all suffer.

As I watch my wife go through this process, I cannot help but realize how similar the process is for the caregiver, the family members, and the survivors. We, too, are passing back, through, over, and around these stages in our effort to understand what is happening to our loved one. My initial Denial and Anger had given way to Bargaining (“this is our new normal, we’ll take as much time as we can get”), when on any given day, I can slip easily into Depression and back to Anger only to wake up the next day after a dream in Denial. No seatbelt or ABS brake can prevent that whiplash.

I cannot imagine a day when I have reached Acceptance because Kübler-Ross also wrote:

 “The reality is that you will grieve forever. You will not ‘get over’ the loss of a loved one; you will learn to live with it. You will heal and you will rebuild yourself around the loss you have suffered. You will be whole again but you will never be the same. Nor should you be the same nor would you want to.”

Am I grieving already? Yes. Am I confusing the “stages” and grieving? Perhaps. All I know is that each day (and often times several times within a day) brings a new emotion for which I am unprepared, I thought I had made peace with, or I anticipated would bring me peace, only to find myself confused and lost again. And one of the worst emotions I carry is that I know that while I am suffering the whiplash of these stages, I am not the one dying, I am not the one suffering or actually going through Kübler-Ross’s stages of the terminally ill. As she also wrote, “Guilt is perhaps the most painful companion of death.” Suffering has lost its meaning because we all still suffer.

Inhuman

PainPublilius Syrus in the first century B.C. wrote “when Fortune flatters, she does it to betray.” Plutarch reinterpreted this as “I see the cure is not worth the pain.” Somewhere over the past two thousand plus years we have lost the connection between humanity and the humane.

Setting religion aside and ignoring the politics and ethics of Dr. Kevorkian, it is, none the less, barbaric how we treat our loved ones at the end of their lives.

We have somehow bridged the moral abyss with compassion for our beloved pets by “humanely” putting our beloved pets out of their senseless misery, ending their meaningless pain, answering their pleading eyes with the selfless, heartrending compassion of euthanasia.

We have somehow sanitized capital punishment of the worst criminals from fatal and barbaric corporal punishment to a “humane” (although still debatably barbaric) dream-like sleep out of existence.

And yet, we allow our loved ones to face “natural” death filled with a fear, pain and confusion making anything that happened at Abu Ghraib look like Walt Disney World.

This suffering is multifaceted. Of course, there is the physical pain, which is no better controlled today than it was 50 years ago. The opioids still rule as the best we have to offer. The problem is that they are systemic, meaning that they travel throughout the entire body. If the pain is in the hip, the hip gets the morphine, but so, too, do the little finger, the ear lobe and the brain. The result is that the little finger and ear lobe are no better or worse, the hip suffers an incomplete relief of pain and the brain suffers the confusion, paranoia, nausea and narcolepsy unnecessary to treatment. This is the best medicine has to offer in 2014? The other suffering it brings is to the family members who must endure watching the physical suffering of those they love hampered by the incomplete relief of pain. Meaningless suffering is the worst kind. Love of another means the willingness to shoulder their burden. The helplessness felt by the family member watching their loved one jerk in pain or crying out as they try to move them or comfort them is an indelible stain on their soul.

The suicidal mission of cancer adds to the frustration. Bent on destroying its host, even at its own annihilation, cancer never rests. To paraphrase Siddhartha Mukherjee from his book The Emperor of All Maladies, cancer cuts the brake lines of some cells and jams the gas pedals of others, stopping the natural cell regulation process and sending the cancer cells into a proliferating frenzy steamrolling every other cell in its path. In his or her clearer moments, so too, the cancer patient undergoes a civil war; one side, engrained in all of us, pulls us to live, to continue fighting, while another force, armed with logic, understanding and ultimately love, forces the patient to begin facing the inevitable truth with no regrets and peace.

In his book Man’s Search for Meaning, concentration camp survivor and psychologist Victor Frankl describes inmates of the camps as surviving long stretches if they could find meaning in their suffering.  Some held on to the hope of outlasting the Nazis and returning to their loved ones (should any of them have survived), others found peace looking up at the sky and imagining conversations with their loved ones wherever they might then have been. Life was worth living if they held a kernel of meaning in their suffering.

I have searched and considered and yet find no meaning in the suffering loved ones endure at the end of their lives given the current state of medicine. Pain is pain and on a scale of 1 to 10, anything above a 1 means the medical field has failed. The root word of both humane and humanity is human, from the Latin humanus. However, we reserve those words for our treatment of pets and prisoners, not our loved ones. For them, and for ourselves, it is inhuman what we put them through, for them and for us it is nothing short of torture.

Real Life

wild rabbitEarly in high school, a friend of mine asked if I would like to shoot soda cans and bottles in his back yard. Having been born with a heterogametic chromosome configuration but into a world without the sanitized war of Halo (1-4) or Call of Duty (1-10) or Battlefield (1-11, plus 12 expansion packs), I said yes. My friend had a pneumatic, pump BB gun. We walked into the woods where he had obviously done this before, based on the aluminum debris littering the area and various shards of different colored, broken glass beside a fallen tree. We lined up cans and bottles (sometimes only the bottoms of bottles whose tops had been shattered) on the fallen tree. Because there was only one gun, we took turns shooting at the cans and bottles. And while every boy considers himself an expert marksman, fashioned after the likes of John Wayne or Dirty Harry, actually hitting the can or bottle proved a little more difficult, no matter the distance we stood from the targets. Real life is funny.

We laid down on a bed of dead tree leaves, twigs and the odd clumps of grass determined to grow despite the lack of sunlight and peat-like soil. Lying prostrate on the ground improved our aim a little and I actually hit a can or two. It was while we were on the ground that, beyond the fallen tree holding our targets, we saw a rabbit emerge from behind a thin, switch-like pine. My friend, holding the gun, quietly loaded and pumped the gun, giggled and took aim at the rabbit. Instantly, my stomach went to ice. Time slowed down as my eyes locked on to the little rabbit and competing thoughts fought to make it to my paralyzed tongue. Should I yell at my friend not to shoot, or scream at the rabbit to run? I jumped when the shot went off, and so too did the rabbit. Unlike the movies where bad guy falls instantly dead, the little rabbit jumped repeatedly into the air, never making a sound, but wounded and in extreme pain. To this day, writing this, the events are before me in Technicolor. My friend, equally silent, watched the wounded rabbit, smiled, got up, reloaded the gun, walked over to the panting, confused, bleeding and exhausted rabbit and shot it again, killing it. Real life.

I could go on and on about how America is awash in guns, desensitized by violence and more knowledgeable about the Kardashian’s and sports than Orwell or Shakespeare, but that’s for another day. Suffice it to say that it seems bravado and showmanship have eclipsed education and empathy in America.

I share all of this because I am again haunted. Driving home from the supermarket Sunday, I was in the left lane of a four lane divided road. In front of me and in the right lane (having just passed me on the right) was an enormous white Suburban. Ahead of us, on the grassy median strip was a small squirrel. Apparently frightened by the sounds of the oncoming vehicles, the squirrel attempted to seek shelter in the trees across the street. Again, time slowed down and I will forever have it in Technicolor horror. The squirrel darted across my path about thirty feet in front of me as I slowed down, somehow knowing the squirrel’s intentions. The Suburban, oblivious and in a hurry did not. The squirrel somehow managed to cross under the truck after the front left wheel and before the left rear wheel. There, it momentarily froze under the train car-length automobile, pulling in its bushy tail and almost holding its front and rear paws together in an attempt to make itself smaller. I can imagine the thunderous noise in the animal’s ears.  Unfortunately, this life saving maneuver was held only fleetingly. The squirrel tried to make it to the curb, grass and trees barely two feet away, only to be hit by the right rear tire. As if hitting play on a long paused nightmare, the squirrel jumped repeatedly into the air, grievously wounded, then it hit the ground one last time, fell on its side and moved no more; the rabbit’s death years ago drowning my thoughts. Screaming and swearing, I made my way home, parked in the garage and cried. Real life hurts.

Real life is neither a movie, nor a video game. And while it can be beautiful, inspirational and compassionate, sometimes it is ugly, painful, unfair and hurts.

Road Rage

I must admit to a certain bias.  Not to open the age old rift, but I fancy dogs more than cats. While I can accept the anthropomorphic attributes of wisdom, solitude and supremacy that we impose on cats in an effort to embrace them as something other than the self-centered, personality restricted, hangers-on that they truly are, I rather prefer the capricious, attention seeking, connection of a dog. The dog yearns to become part of a family, to participate in activities, offers affection and seeks attention.  Is this any different than me?  And while I anthropomorphize them and admit to attributing human emotion to their actions and reactions, I will not apologize.

I confess that I was fortunate enough to have been raised with dogs, and while their names (Bozo, Booker and Pandora) mean nothing to you, they engender warmth and familiarity on par with that of siblings to me.  Their deaths were no less painful than those of my grandparents, having occurred during the same era of my life. Now, as a father, the addition of our dog Delbow to our family offered no less enchantment.  When we welcomed him into our hearts, he was only eight weeks old and my twins were only nine years old.  Missing only the white picket fence, our future was a pastoral Rockwell painting.

Unfortunately, the past nine years has seen us leave our wonderful home, family and friends in Rhode Island and move to Texas to fight my wife’s aggressive, single-minded (though unfathomably suicidal) breast cancer, forced my children to uproot their lives and face parental mortality sooner than should be required and witnessed the various medical afflictions with which our beloved dog has had to endure (from blindness in one eye due to a retinal detachment, to emergency surgery to save the other, to two tibial plateau leveling osteotomies following two ruptured cranial cruciate ligaments, to surgery and radiation for a cancerous tumor in his neck).  In short, the life we had planned vaporized with the unwelcomed arrival of that insidious cancer and we have done our best to remain a family, drawing strength from each in our times of weakness under some unnecessarily painful and harrowing conditions. My wife fights on, my children pursue their lives and Delbow continues to offer his boundless affection.

It is against this backdrop that I share with you now my vexations at the way in which dogs are treated here in Texas (or at least in the area I travel daily to and from work). Not a week seems to elapse without my seeing the body of a dog lying by the side of the road. My anger comes in waves, my heart breaking.  Unanswerable questions flood my mind.  What home did this dog belong to? What must the family be thinking? Do they know their dog is missing? Do they know he is dead? Are there children in the home, facing the loss of their beloved boon companion? How could they not have secured their dog? Did he escape by accident? Did someone leave the door or gate open and now must endure the timeless misery of guilt?  Why does he lie there, day after day? Does no one care to retrieve him?

Sometimes the dog looks like he simply put his head down on the side of the road and slipped into a peaceful eternal slumber.  Other times, the carnage left by the accident leaves me hoping that pain was inhibited at the moment of impact. Either way, there is no excuse for these creatures to remain in their final repose for weeks on end. Soon bloated and fetid, and eventually transforming into a fur bag holding only bones, accumulating the dust and road grime wafting ever over them each day, they seem to linger there, pleading for exemption, crying in silent strains for finality as I hurry on my way, unable to avoid the scene, unable to look away.  Like some highway of death, this well-traveled road tears anew the gash in my heart every time I see the next victim.  Left there to die, and just left there.  Will I become accustomed to this over time?  Will I no longer see death’s hand by the side of the road?  Will I no longer have all of these questions surge through my mind?  I hope not. To have your heart broken requires a heart to begin with and and while mine tears anew, I defend against the nerve dulling scars and callouses that repetition imparts.  I am grateful for my Delbow and yearn to get home to give back to him that which he freely offers.