Some of you have asked for a follow-up to my 2007 essay, Mechanics, Plumbers, and Physicians, in which I wrote about my cousin, Bruce, who had recently been diagnosed with melanoma.
Bruce had just had a clear PET scan and the final diagnosis was unknown. Neurotropic melanoma? Probably, of some sort. Spindle call? Desmoplastic? My physician brain wanted a diagnosis and my everything-else brain was focused on being with him.
When Bruce called me to share his diagnosis his two medical concerns were that he not be in pain and not lose control. He wanted to stay alive for his kids to teach them more of “life’s lessons.”
After the diagnosis
And so began a long journey from diagnosis through the therapies he chose, morning smoothies full of nutrients and an eventual slowing down, as he quit playing handball, then stopped his walks, eventually unable to get out of his bed.
Bruce and I were both born in Long Beach, about six years apart. His family stayed. My family left. We reconnected when I moved to Los Angeles for graduate school. He was an athlete; I usually live in my head. He held swimming records in high school, rowed a dory to Mexico and surfed Huntington Beach. I restricted my athletic pursuits to pool swimming, riding horses and lying on the beach in my bikini as a wannabe wahini, or surfer girl. I did, after all, know most of the Beach Boys’ lyrics, had a garage sale 10’ surfboard in my living room on display and had even met Jan Berry, of Jan and Dean and “The Little Old Lady from Pasadena.”
While I was at Baylor College of Medicine in Houston Bruce drove out to visit. After a week or so he headed south to surf along Mexico’s Pacific shore, inviting my neighbor, Charles, to join him.
Charles remembers, “Some of my best memories are of the trip he talked me into down to the Pacific Coast of Mexico. His free spirit was infectious; I couldn’t think of one valid reason NOT to go when he pressed me, so off we went, the two of us with all our camping gear and his surfboard crammed into his little gray VW bug. The New Year’s Eve we spent together on that trip, camped out on the beach, was easily the most memorable of my life as well as the least expensive. There’s got to be a lesson there.”
Since I wrote about Bruce, he went through more Mohs surgeries, losing his nose and gaining a silicone prosthesis. He lost his balance. Imaging showed a brain metastasis, which was removed and his balance improved. His oncologist recorded the cancer’s relentless march through his body—armpit, groin, and abdomen.
Bruce was offered a “compassionate use” trial of a “soon-to-be-FDA-approved” immunotherapy drug, ipilimumab, or “ipi.” He went through a month of chemotherapy-induced nausea and weakness to qualify for the ipi. Bruce’s oncologist said he was the calmest patient he’d seen as he faced death. Bruce didn’t want to burden anyone, even his kids, during the four years he lived with melanoma. Only Linda, his wife, really understood what he was going through.
January 13 I was in Salt Lake City for a conference and Linda called me.
“I think you might want to come soon. Next weekend (when I had scheduled a trip) might be too late.”
When Bruce was first diagnosed I promised I’d be with him when he died. I booked a flight to Long Beach, where I stayed the weekend, working on my computer at the kitchen counter. I watched a steady stream of friends, alone or in small groups, stop by the house to say goodbye to Bruce – his handball friends, his lifeguard friends, his marina friends, his surfer friends.
As his surfer friends were leaving one of them said, “How about catching a few waves?” and the group of gray-haired 60-something guys left to surf.
Not a typical Washington, DC event.
Bruce could still talk, but tired easily and so his visitors were limited, then restricted to a very few of his closest friends. He even managed his trademark left eyebrow lift, accompanied by a look that said, “Are you kidding?”
He agreed to oxygen and an in-house hospital bed on that trip. Bruce was stubborn, practical and didn’t tolerate fools. His mother had been a Christian Scientist and he visited physicians only when necessary.
January 21 I flew to be with him. I arrived at the house, dumped my carry-on in the living room and headed to his bed, where he was “minimally responsive.”
I sat on the chair next to his bed, stroked his left arm and rested my head on the bed railing.
“Bruce, it’s Maggi. I’m here. I love you very much.”
Bruce’s son and daughter, Jody and Jessica, together with their significant others, Natalie and Jermaine had been standing watch, taking turns to gently cradle his head and talk with him.
Seaward, a Christian Scientist, coincidentally needed a place to stay while in Long Beach and read to Bruce every day. Linda’s friend, Deby, brought holy water from Lourdes and said the Lord’s prayer over him. A handball colleague who was a rabbi came by to say goodbye and give his prayers. A Buddhist friend also performed his faith’s rites.
On January 23, 2011 at around 9:30 pm he stopped breathing, quietly and without fanfare, just as he had lived his life. Grace personified.
We stood around him, kissed his warm body and hugged. His wife placed a jade cicada next to his head, telling us in China an old custom had been to put a jade cicada in the dead person’s mouth. The cicada’s racket would prevent evil spirits from detouring the deceased’s journey.
We hugged again in silence. I reached over to close Bruce’s eyes.
As I reflect on this I think of all the deaths I have seen in hospitals. A heart stops beating and the loudspeaker blares, “Code Blue. Room 875.” Like warriors from the dragon’s teeth Athena gave to Jason, the code team appears. In teaching hospitals, the residents on duty run to the room to watch yet another spectacle. Maybe they can practice intubation after the person dies?
The team members flail at another heroic effort to save a life. Lights blinking, loud noises from the various machines, staff jammed into a tiny room, spilling out into the hall.
“Who’s got the epi(nephrine)?
Sometimes, “What’s the code status?”
People never get cancer alone. The whole family (friends, loved ones) gets it. As I watched Bruce, I hopes we all can go as he did, death with dignity, surrounded by those who love us.
As the Wizard of Oz said to the Tin Man,
“A heart is not judged by how much you love, but by how much you . . . are loved . . . by others.”
Bruce was well loved.