What we fear most sometimes ambushes us when we are otherwise preoccupied with challenges we believe are, in themselves, about as much as we can take. My husband had a brilliant (if sometimes perplexing) mind. He was a wordsmith and the keeper, in our household, of obscure words and interesting etymology. He was a deep thinker, though he occasionally proclaimed that if personal depth could be compared to the depth of a pond, his would be revealed as being only ankle deep. I felt it would be measured in fathoms, not inches.
The decline he experienced the summer and early fall of 2010 was mostly a physical decline, not a mental one. He could handle the physical decline, even if he did not like it. His worst fear—and mine for him—wasn’t physical decline, but losing his mind during the downward spiral.
The threat of that ambushed us in mid-October. One of his closest friends, Andy Wilkinson, was visiting from Texas. I had urged Andy to visit because I feared that Howard might die before they had a chance to see one another again and something in my sense of urgency had gotten through to him.
Neither Howard nor I thought much about the MRI scheduled during Andy’s visit. There had been so many scans and tests over the previous three years that I no longer gave them much mental or emotional air time because they almost never revealed anything important or even useful. But the MRI had been scheduled because Howard had reported some rather puzzling symptoms during a checkup. He’d been having a certain numbness on one side of his face that seemed to be present when he was prone and went away once he was out of bed and moving around a bit. He hadn’t been quick to tell me about it and when he had, he hadn’t seemed overly concerned. The fact that he had actually informed me of the symptom should have told me more than his seeming lack of concern about it. But my antennae must have been slightly misaligned that day.
I’d chalked it up to his overall lack of mobility. The blood just wasn’t having a chance to circulate like it should. I had little fear of stroke because it didn’t fit the kind of numbness connected with stroke. He and I had both noticed that words were occasionally failing him, too, but that didn’t alarm me, either. It wasn’t severe and I thought it to be symptomatic of his overall decline.
The MRI was just a minor interruption to an otherwise lovely visit by Andy. In fact, Andy went with him to the appointment.
His doctor called the house before they returned. The cancer had metastasized to the dura—the covering of the brain. There were also a half dozen nodules between the dura and brain, one of them large enough to be putting some pressure on the brain. That was probably what was causing his symptoms.
This was the first time in fifteen years his oncologist had seen this kind of metastasis in one of his prostate cancer patients. The online research I did later suggested that cancer metastasizes to the brain in 1-2% of prostate cancer patients and that this percentage might actually be inaccurately low based on the autopsy results of some men who had died of prostate cancer. It would seem that the cancer might be finding its way to the brains of these men more often than assumed, but when it did, they often died before it was discovered.
As his doctor talked, it seemed to me that the fear I’d never allowed handhold, foothold, or any purchase at all in my mind was standing in front of me and making faces, instead of just climbing around in my head. If the cancer continued to spread in this area, any number of alarming and deadly things could happen, depending on the part of the brain impacted. He could have seizures. His ability to swallow, breathe, see—in other words, his ability to perform one or more bodily functions necessary to live—might be impaired. He could lose his ability to speak . . . or even think. The possibilities were ugly.
I was in tears when he and Andy got home. One look at me, before I said a word, told Howard that something was very wrong. I don’t think he immediately connected it to the MRI because, like me, he hadn’t expected the MRI to tell us much. Andy was an innocent caught in a drama he hadn’t auditioned for. Fortunately, Andy was as good a friend and as strong a man as I had always believed him to be. But he’d come to our home without having seen, first hand, Howard’s decline over the past few months and was now finding himself in something of a B-grade horror movie.
I think Howard’s doctor had been in shock, too. He didn’t hold out much hope for doing anything about this newest development during my initial conversation with him. But by the time we saw him, less than two days later, he had a plan. We could do nothing about this newest development. Or . . . Howard could undergo a round of radiation treatments, not to effect any “cure,” but to mitigate some of the potential consequences of the metastasis. In other words, if we were lucky, Howard might continue his pilgrimage toward death and ultimately die without losing his senses or his mind.
Neither of us was keen to have him undergo radiation treatments, but we were both relieved by the sliver of hope that having them might allow him to maintain some of that keen mental prowess so important to him.
I found myself supporting the idea. Howard had chosen an allopathic, conventional approach to the treatment of his cancer. It was not an approach I liked. It was an approach I doubted I would take if I were diagnosed with cancer. Yet, here I was—the woman who mostly disdained the entire approach to medical “care” in the Western world—not only supporting radiation treatment, but feeling grateful that it was an option.
As for Howard, he never wavered from his stance that Death was going to have to do more than show up and invite him to depart, it was going to have to wrestle him—like the angel who wrestled Jacob through the long night. The poet Rainer Maria Rilke once wrote that it is not winning that tempts the man who would wrestle with such an angel. On the contrary, the man who would undertake a match like this would have the wisdom to know that being defeated by such a powerful being would make him more than he had been before the match.
Perhaps, but Howard wasn’t quite yet ready to surrender in this way. He wanted to hold on to any shred of his physical presence that he could . . . and as much of his mind as could be bargained for in the delicate negotiations between Death, allopathy, and his own considerable will.
Copyright 2011 by Melanie Mulhall