The endgame by Derek K. Miller

1 Dec

In the next couple of years, about 100 million people will die around the world—of old age or other natural causes, in accidents, of infections, from pathogens or poisons, in wars and terrorist attacks, from congenital defects, in fights, of suicide, in natural disasters, from medical errors, of exposure, by misadventure, by assassination or murder, and of various diseases and conditions. Between 10 and 15 million of those people will die of cancer. Today I’m telling you that I’ll be one of them.

It’s good that Thursday, November 25, wasn’t Thanksgiving Day in Canada (it was in the U.S.), because that’s when I found out. Doctors are notoriously reluctant to predict life expectancy, and for good reason—they’re often wrong. But, with my wife Air in the exam room at the B.C. Cancer Agency with me, I drew it out of my oncologist, Dr. Kennecke.

“Do you expect I’ll still be alive to visit you here in two years?” I asked, straight up.

“Honestly, no,” he said.

There was more to it, of course, but that was the moment. It was no surprise. It’s why I had asked Air to come along—she hasn’t needed to join me for a doctor’s appointment in a long while, but this week I needed her there.

How do I know?

My chemotherapy isn’t working anymore, and after almost four years of different cancer treatments, standard and experimental, I’ve run out of new things to try. My tumours are still growing in my lungs, chest, and abdomen, so this week my doctors and I have agreed that I’m going to stop taking the drugs. I’ve probably got about a year before I die, give or take.

I discovered I have cancer at the beginning of 2007. Since at least 2008, it’s been clear to me, after radiation, surgery, chemo, and everything else, that none of the treatments was going to destroy it or cure it. I’ve never been in remission, and with every CT scan and blood test it’s been plain that the number and size of the metastatic tumours in my body has nearly always continued to increase, slowly and steadily. The direction of the arrow has been obvious—to me, to Air, to our two daughters—for a long time.

Chemo is never easy. Coincidentally, I discovered a couple of days ago that it was first developed from World War I bioweapons like mustard gas. Since late this summer, the latest cocktail has certainly felt like that. It’s been brutal, probably doing more harm than good, not poisoning cancer cells any more effectively than it hammered the rest of my tissues. That led to side effects I’ll be glad to reduce, and the weight loss I complained about last time I posted here.

My body is broken and failing. Precisely how long it will hold out, no one knows. But it won’t be very long.

What happens now?

Importantly, I’m ready to accept it: I need to prepare to die. That’s not giving up, it’s facing reality. Anyone who knows me well, or who’s read this blog for any time at all, knows I prefer to do that than to be deluded or in denial.

As lifespans have soared, our society has become lousy at dealing with death. I regularly receive emails from people I don’t even know, who seem desperate to tell me about a very specific miracle treatment that I simply must take. They have good intentions, but it also feels to me like they refuse to believe that an otherwise fairly healthy 41-year-old man can get cancer and die, and there’s ultimately no way to stop it. It seems to offend how some people understand the world.

Yes, I’ve looked into the options those people suggest, and the evidence for their effectiveness just isn’t there. Many of the purported treatments would bankrupt my family and further disrupt our lives, almost certainly for no good purpose. The truth is that I have cancer, and it’s going to kill me, soon.

I don’t yet know exactly how things are going to go. The Cancer Agency has teams of people to help once patients (and our families) determine that we’re terminally ill. I’ll need more pain medications with time, and stronger ones. Since most of the cancer is in my lungs, I’m guessing I’ll need supplemental oxygen eventually. At some point I may have to move into a hospice or check into a hospital permanently.

I don’t play chess, but it includes the useful concept of the endgame, when tactics and strategies change because the remaining pieces are few, and the players know the game is almost over. That’s where I am, so I know a few things.

As I predicted, our dog Lucy will outlive me. This might be my last Christmas, or I might see one more. I may or may not reach my 42nd birthday next June. I’ve probably bought my last car and pair of eyeglasses, but my final carton of milk and cup of coffee are some way off yet.

Facing my own death isn’t easy. It’s tremendously hard for my immediate family, for my parents, for my aunts and uncles and cousins. It may be harder for them than for me—after all, I know I won’t have to deal with the aftermath. I’ll be dead, and they’ll be alive.

Still, I’ve had a lot of time to think about death and dying since the beginning of 2007. My wife and two daughters—my three wonderful girls—have talked a lot with me about it too, and we’ll keep doing that. I’m not ready to die just yet, but I’m ready to prepare for it.

Off we go.

Via Penmachine

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One Response to “The endgame by Derek K. Miller”

  1. Pismititsflut 25 January 2011 at 15:57 #

    Nice post! I do not know how to show my gratitude and cannot say enough good things about…

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