I’m especially happy that my family is here tonight. I’m sure like most of you, when I was practicing, I spent a lot of time at work. Undoubtedly too much, but that’s a topic for another day. But off I did go, and my family, especially Ben and Elizabeth who are here tonight, could not in any way really know what I was doing, with whom I was doing it, and whether I was doing it well. I was just ‘at the hospital.’ Well, it means a great deal to me that some of those blanks will be filled in tonight. Most importantly, they see who I valued as colleagues and friends, and they can feel, as do I, your generosity of spirit by being here. Thank you.
When I told people that I was going to speak with a group of predominantly oncologists about confronting mortality, the responses ranged from, “Wow, that’s a challenging group!” to “Are you frigging crazy?” Well, we’ll see which end of that scale we end up on. One thing I can guarantee is that this will be the most unusual CME credit you have ever received.
While this is mainly addressed to the oncologists, it is to each one of you that I owe my continued survival and my staggering gratitude. It’s my hope that you’ll head home tonight feeling good about yourselves and how you have impacted this one human being. Maybe you’ll also take away something that might have some relevance to how you lead your life.
Each of you here tonight has given me something for which I am grateful. Some have worked on my insides, some scanned or X-rayed me, some radiated me, some have kept me going with every therapy available, and some of you have given me support by simply tolerating my ramblings at conferences. And then there are those of you who have carried me, both emotionally and on occasion literally–those of you who are close friends and most especially my family.
When I was practicing, I loved oncology patients. I had been doing thoracic surgery throughout my career, but when I came to KU, I gave up cardiac surgery and limited myself to general thoracic. With oncology, I loved the interaction that I had with the patient and family, the technical surgical challenges, and the collaboration that I had with you.
That’s not to say that I always understood you and what you do. And it should come as no surprise to you that around the medical community, nobody outside of oncology understands you. Why would someone want to deal with so much death? That’s the usual question. A surgeon’s approach makes a certain amount of sense: take out the cancer and offer a pretty good shot at being benefitted. But you have embarked on an approach in which the only sure things are staggering expense, guaranteed toxicity, and often very uncertain chances of cure. Why would anyone want to do this?
Or so I wondered until I was diagnosed with prostate cancer at age 54. As we all know, there is good prostate cancer and bad. The good kind is the one that everybody’s Uncle Herman got at age 80 that gave him no trouble at all. Believe me, I’ve heard a great deal about many, many Uncle Hermans, which is news that people like me with the bad kind of prostate cancer receive with both resignation and resentment, because it demeans everything that this disease has put me, my family, and my friends through. Don’t get me wrong, I’m really very happy for Uncle Herman, but for me to be standing here today, I have undergone a radical prostatectomy with all that that entails, pelvic radiation therapy, somewhere between 45 and 50 sojourns to those Barkaloungers (cycles) to receive a variety of differing chemotherapy protocols, hormone deprivation therapy and all that that entails, the bizarre need to have my breasts radiated and my pelvis tattooed in peculiar places, immunotherapy, radiation therapy to bone metastasis, experimental protocols of additional hormone manipulation, and two hospitalizations for complications of therapy. Despite all this, my bone scan shows extensive metastatic disease. So with all respect to Uncle Herman, my cancer has given me plenty of trouble, indeed it’s pretty assuredly going to cut my life shorter than I had ever contemplated.
But for now I am alive. And I would add very much alive. And I am here to sing a song of gratitude. I realize that it is hard to prove a negative, but I am convinced that I would be long dead were it not for the treatment and support that I have received. And the time that you have given me is a gift of immeasurable magnitude. It’s a gift that I have tried to make the most of. Believe me, I now understand oncology and what you do.
Let me pause here and say a word or two about my take on the particular issues that face a physician with advanced cancer. I have been blessed with the best of care from many of you, but most especially Pete and Jennifer, both of whom I love and respect beyond measure. As a physician, I know excellence, and there it is. And I know character, and there it is. I have never doubted or second guessed any thoughts that they have had about my treatment. I have never scoured the Internet for alternatives. Contrary to recent data, I will not in any way blame my doctors when things go seriously South. I would say that other than getting some test results pretty much immediately, I think I have been treated as an equal with everyone else, which is how I hope it would be, but I guess I’m not sure of that. And getting immediate test results can be a bit of a surreal experience. After getting a CT scan, I get off the table, put on my clothes and walk around to the reading room to look at the scans with the resident. There is some selfishness in this, as a lower rank radiology resident is usually not used to this scenario, especially if there is bad news to be delivered, which has often been the case. But they have always been kind and willing. I always take time to try to put them at ease and to thank them for their help.
While being able to immediately read your own CT scan has its benefits, it is also true that knowing too much is not necessarily a good thing.
All physicians have significant control needs, and having incurable cancer is perhaps the epitome of control loss. It’s difficult to accept. It is not easy to carry in your head the likely unfolding of your disease or possible explanations of any symptom: could that sudden pain in my leg while running be the beginning of a pathological fracture? God, I hope that pain is not sacral plexus nerve invasion. What’s the deal with that headache? And so it goes. And of course, physicians feel they should be especially brave, not wanting to appear weak or over-reacting to their colleagues. And then there is death. Like you, I have witnessed many deaths and harbor no illusions about its beauty or dignity. Though such can certainly occur, more likely it is something best forgotten.
So on balance, I think it’s harder to be a physician with incurable cancer than someone with a different background. But, I hope you never have to entertain thoughts of this comparison. I’d add that many fellow physicians don’t want to engage me about my illness….it seems to scratch too hard at their defenses that such things don’t happen to people in the business.
The English writer Samuel Johnson has stated that confronting ones mortality has a way of “wonderfully concentrating ones mind.” And so it has with me.
I have thought about this a great deal, and I would emphasize the adverb ‘wonderfully.’ What I have experienced is the mindful equivalent of cold water drowning. As you know, in that circumstance, there is a diversion of circulation to the core and specifically to brain, heart and kidneys in a response that maximizes the chance of survival. Well, the concentrated mind of someone with incurable cancer also has a diversion of resources, but in this case there is an amazing refocusing of thought and consciousness in a way that maximizes the appreciation and impact of ones remaining life.
What does this mean? So much of the clutter in my mind has been removed and replaced with a new order and beauty, as if a swamp has been drained and the water replenished from a clear source. There is a new freedom to truly speak from the heart–as I am doing tonight.
I have found amazing power and promise in this relinquishment. Most strongly, I now see with striking clarity the folly and burden of so many emotions and motivations that we carry within us. So much wasted effort. Think of anger, guilt, jealousy, materialism, envy, regret–you can fill in the blanks as they apply to you. Now imagine your life without these. All gone. And that is the gift that all of you have given to me by giving me time to live along with the reminder that I am dying.
With this clarity, I see so much better. I absolutely see miracles every day in this world, I see incredible grace in strangers, I am humbled by the gift of having friends more caring than I ever dreamt possible, and the blessedness of having a wife and family who love me and who have categorically sustained me. And I think better, too. So many preconceived opinions, prejudices, and assumptions are no longer worth the effort and energy needed to carry them. I can view the world through the lenses of my experiences and relationships, but without the filters of prejudgment…. Perhaps the most humbling realization that I have had is that living with cancer has brought me much closer to the person that I always wanted to be.
Considering this audience, I’m really about to go out on a limb. I’m going to use the f word, as in faith. Through most of my life I have had a relationship with a greater power that could charitably be termed contentious. At times I have been ashamedly self-absorbed–a quality that too frequently led me to personalize the misfortunes that befell me and those around me. I now see things very differently. From my new perspective, I have now come to realize and to feel the presence of a fundamental goodness in the world that, while bad things can still happen, is a constant source of beauty, wonder, truth, and love. And that is the God whom I have come to know.
I feel the need to talk about this, because I suspect many are skeptical of foxhole or death row conversions, and of course, I could be so accused. So, the skepticism I accept. But the faith that I have gained is not covering the bet of an afterlife in heaven. I’m not there, and quite honestly, I don’t need to be there. If such exists, all the better, though I suspect I’ll have to plead my case for entry. What my faith has given me is so much more tangible: a voice within me that I can summon whenever I need strength and guidance and comfort. It is a voice that shows me how to behold the wonder in the world. In truth, my renewed relationship with God is the greatest miracle of my life.
For sure, my enlightenment has not been a linear voyage. There have been starts and stops, twists and turns, and plenty of potholes. I’ve had days when I have navigated Elizabeth Kubler-Ross’s five stages in an afternoon, and other days when I have become hopelessly bogged down in one of her lower registers. As my family and friends can attest, there have been many times when I’ve let one or more of those poisonous traits back into play. There have been moments of suffocating sadness where I contemplate all that I will most likely never see. Some things are easily discarded, but I can assure you that dreams are not amongst them. There have been times when the weight of burdening my family has felt crushing. There have been times when I have relied far too heavily and unfairly on friends. And there have been times when the treatments you have given me have left me completely crazy for weeks at a time. But I do see these moments for what they are–testimony to my humanity–and only temporary diversions from a direction to my life of which I have never been more certain or more grateful.
People often ask me how I cope with my disease. In truth, that’s one of those secret of life questions that defies a single answer, and perhaps even a coherent one. To some extent that is because, as I intimated, I can be a moving target. Although the inevitability of my disease has never been in doubt, thanks to you it’s progression has been variable, as have been the emotional resources needed to live with it.
But if I did have to give the most succinct answer to that question, I’d say the key is to maximize the times when you can condense your life down to the moment of your next breath. Savor that moment, and everything that surrounds you, with all your senses. Give up both past and future with equal determination.
As for the past, we all have much that we would like or should leave behind. But the interesting conclusion that I have made is that too much reliance on even good past memories is also destructive: what appears to be a safety net of nostalgia can in reality be a web that ensnares one to the emotional status quo and prevents one from moving to a better level.
As for the future, let me tell you about a brief encounter that I had about a year ago. I was photographing a particularly beautiful sunset in Carmel, California, and I caught the eye an attractive older woman sitting alone nearby on a bench watching the sun descend into the Pacific. We exchanges smiles, I think out of recognition of our kindred spirit at being there at that moment. I went over and we talked. As it turns out, we talked for about forty minutes, as darkness began to fall. She was a retired rabbi, and we spoke effortlessly of life, death, forgiveness, and beauty. At one point, I asked about her children, a daughter in an Israeli settlement on the Palestinian border and a son in the Israeli army. I paused. “Don’t you worry about them?” She did not hesitate for a moment in replying, “Pray yes, worry, no. Worry brings nothing of value.” How right she is. I don’t know where you fit on the scale of assessing such encounters: pure coincidence or part of some plan, but I tend toward the latter. Regardless, her words and her wisdom have stayed with me.
I think she was reflecting the thought of the French philosopher Michel de Montaigne:
“He who fears he shall suffer, already suffers what he fears.” The future never evolves as we perceive it; worry of the future brings nothing of value.
So what do we have without reliance on our past or fear of our future?
Well, that leaves the present. What does one do with the next moment?
I would propose, first, be grateful for it.
Then, find the beauty and joy that surrounds you, celebrate it, and share it with someone that you love.
And believe me, that beauty is everywhere, from nature to relationships to the human heart.
Let me leave you here with one thought. There is nothing unique about my introspection that has led me to these conclusions. If I can navigate these waters, I really believe anyone can. Which is to say that I am convinced in our ability to reinvent ourselves. You can have more than one life, the one that you have lived to this moment, and the one that you will have from this moment on.
Find the beauty and joy that surrounds you, celebrate it, and share it with someone that you love.
And that’s it, but that is everything. And I thank each of you for letting me see it.