I met my wife Mary in 1988. I was a nursing home administrator, she was a Director of Nursing. We married the following year and as we built a life together I moved on professionally and built my own company, one of the most highly regarded Medicare certified home healthcare agencies in Illinois. The intervening 25 years were the best and worst of times, but the best predominated by far. But the worst was pretty bad, starting with a diagnosis of breast cancer, followed by seven years of multiple re-occurrences, a lumpectomy, a mastectomy, two more primary carcinomas, endless ER visits and a gauntlet of surgeries, radiation and chemotherapies.
Mary died October 2013, age 63, but not of the breast cancer that continued to plague her. There was no family history of cancer; fate seemed to have saved it all for her. So even as she received treatment for a recurrence of breast cancer, when she ominously began to discharge blood, we nervously hoped for the best but feared the worst. The worst was soon confirmed when her oncologist, with a very long face and conspicuously sober demeanor, told Mary she had a uterine sarcoma, a relatively rare and particularly aggressive form of cancer. The tumor was surgically removed in February but was back again in March. It returned after being incinerated by radiation and survived once again after being starved by embolization. Mary carried on bravely, maintaining what routines she could, hoping to rescue a failing body with a positive mental attitude. Then came the hammer; nodules were growing in her lung. I’ve never before heard of anyone looking forward to a diagnosis of breast cancer, but we were all hoping the resulting biopsy would prove to be a metastasis from her lymph nodes. That type of cancer, the doctors explained, was much more susceptible to chemotherapy. But no such “luck.” Not only had the sarcoma proved impervious to treatment, it had metastasized.
No matter how much it may be expected, a diagnosis like that comes as a shock. The impossible had at last become the inevitable. Mary’s tears had dried by then and been replaced by resignation, but I shed a few on her behalf. Her first impulse was to forgo further treatment. But within days of confirming the metastasis Mary’s discouragement yielded to determination and she continued treatment, hoping to defy the odds. I remember sitting in the oncologist’s office during a follow-up examination. Mary was seated across from her doctor adorned in one of those lovely creations that open in the back, when she quietly asked “Am I dying?” After a brief moment of silence lasting several hours, without looking up from the notes she was entering in the medical record, her doctor replied “no.” Mary’s doc was as compassionate as she was highly skilled, dedicated to Mary’s well-being. Her terse response may have been arguably correct (there’s always hope until there’s not) but her response was a resounding, unequivocal evasion. That’s a difficult conversation even for those practiced in the art, and physicians are rigorously trained to cure but not necessarily to heal. So, Mary was not dying, not until the moment she developed a fistula and her oncologist recommended hospice.
I’m uncertain if it was due to the heavy dose of opioids or the progression of the disease, probably both, but Mary’s physical strength and mental cognition steadily declined after that. I remember one evening sitting on the love seat across from her bed, watching her sleep, although I was seldom sure when she was sleeping or not even when she spoke, due to the sedative effects of her meds. She liked to see me there when she woke up, sometimes a bit frightened. Her hands were folded across her chest, eyes shut and mouth slightly open, and I swear she looked like death. She stirred a bit, a puzzled, almost pleading expression crossed her face as she reached out both arms, gesturing. Silhouetted against the lamp shade I noticed that her hands were shaking uncontrollably. In retrospect, I think it equally probable that what I interpreted as a pleading expression was in fact a joyful welcoming. She often said how she longed to hold her much loved Daisy, her “doodle bug “ beagle, just one more time. I picture her in a better place at that moment, overjoyed with reunion, arms open to receive her ear flopping, onrushing puppy.
There came a time when I could no longer care for Mary at home. Near the end, on the eve of our 24th wedding anniversary, it was her wish to forgo food and water to hasten a comfortable death. She was kept under terminal sedation for six days before the lack of fluids and the accumulation of toxins stopped her heart from beating…the last week of her life and the longest, most agonizing week of mine.
I would spend each day at the hospice center, going home at the noon hour to feed myself and the children, a dachshund named Little Ricky and a one eyed cat named Fergus. Each time I returned to the facility, the GPS would remind me that I would reach my destination in 300 yards. I knew the way, but relied on the GPS to spare me the effort of concentrating. And each time I approached I thought of Mary, unconsciously waiting to die. What would she think, what would she say if she had the gift of prophecy and knew that sleek building 300 yards in the distance would be her last earthly destination? And my destination, where and when would I be arriving? It is the journey after all, not the destination, but had it been worth the trip? When my time comes, will I be afraid to die because I had been afraid to live? How can I purposely inhabit the rest of my life? These questions leaped to my mind in the interval it took me to turn off the intruding voice of the GPS. Now was not the time, but soon: we are all just one breath away from infinity.