Part 10. The First Time I Died
& a Gut Check
All of our lives we know we’re going to die. But then it becomes a reality, not a hazy, distant concern. When I heard those words from a physician — you have cancer — death became a reality.
Suddenly, Death sat on the seat next to me as the train hurtled me home. My encyclopedia of useless information — I speak of my brain — paged through the Death entries on file.
Henry James said, “So here it is come at last – the distinguished thing.”
There’s that quote often attributed (but falsely, I believe) to Hunter S. Thompson: “Life should not be a journey to the grave with the intention of arriving safely in a pretty and well-preserved body, but rather to skid in broadside in a cloud of smoke, thoroughly used up, totally worn out, and loudly proclaiming ‘Wow! What a Ride!’ ”
And again, from Woody Allen: “Life is full of misery, loneliness, and suffering and it’s all over much too soon.”
True that, Woody.
And I would die in a distinctly unglamorous way: death by asshole. How fitting.
It wasn’t pain that I feared. If I was going to die this way, I knew that it would be in that haze of which I spoke — a tissue of medication and incoherence into which i would slip.
It was not the act, but the aftermath — of being gone, of being so totally absent — that I feared most.
And I believed in some way I’d been there before: I’d visited death.
The first time I died was Thanksgiving Day in 2001. Nicole and I were married that July and she was already pregnant by fall. She wanted to spend the holiday with her father, who lived in Santa Fe, so we loaded up Savannah, then five, and my daughter Sarah, then twenty-one, and her boyfriend, Ryland. Jack was our silent passenger, deep within my wife’s belly. Thinking back, that’s probably the only time that wonderful kid has ever been silent.
It was our first flight since the September 11 terrorist attacks and we were all a little anxious, but after eye-balling shady passengers for four hours and planning to neutralize ruffians with my devastating choke-hold, we landed without incident.
Nicole’s father, Danny Cisneros, picked us up at the Albuquerque airport and drove us to his condo in Santa Fe.
Danny and his roommate Mark were preparing Thanksgiving dinner for a significant portion of Santa Fe’s population.
We got to his place Wednesday evening and discovered he already had two or three dishes going, the turkey readied to cook all night, and enough wine to supply a week’s worth of Roman orgies.
We were tired, so I had a couple beers and went to bed. Since Nicole was pregnant, she didn’t drink, and snuggled with Savannah in our guest-room double bed.
I don’t like bodies poking me at night, so I didn’t sleep much and finally got out of bed around 5:30 on Thanksgiving morning. Danny was already in the kitchen. The turkey was done, the yams were ready and he was working on oyster dressing.
My contribution to holiday meals was my Nuclear Green-Bean Casserole. This is not your father’s green-bean casserole; its key ingredients are sour cream and cheese. I put that together and had it ready for the oven before the guests arrived.
Gradually, the house awoke. Mark was a church organist and he took Sarah and Ryland to services, because actors Val Kilmer and Daryl Hannah attend the church and Sarah wanted to stargaze. She came home afterword and reported that Kilmer attended services dressed as a pilgrim.
Everything was more or less ready by late morning. Guests were expected around one o’clock.
“I’m all tired out,” Danny said. “I think I’m going to go lie down for a bit.”
We didn’t see him for another twenty-four hours.
Meantime, the friends began arriving. I’d met most of the guys when they’d come to Key West for our wedding, so I wasn’t my usual socially awkward self. Nicole is one of those people with an overabundance of the hospitality gene. She was knee deep in an uncomfortable pregnancy, but still turned on the immense reserves of charm she reserved for company.
Friends kept showing up with desserts. Some assembled in the living room and others drifted to the large back deck, which had a beautiful view of the Ortiz Mountains.
Danny’s friend Roger brought two Pyrex dishes of brownies. I’d already had a few beers, so my judgment and manners were impaired.
Roger set down one of the trays near me in the living room. There wasn’t a huge rush for it, so I began eating brownies in my regular style — using my fingers as a backhoe and regarding the brownies as earth in need of removal.
I gobbled a few delicious scoops when I heard a noise from above. I looked up the stairwell and saw Nicole at the second floor landing, shaking her finger at me and mouthing stop.
“You know those are loaded, right” Roger asked, amazed at my lightning-quick excavation of his brownies.
“Oh yeah?” Another scoop.
“I put Marinol in them,” he said.
“I love Marinol,” I said. “Danny gives me some when I’m stressed or can’t sleep.” Danny and several of his friends had prescriptions for this form of medical marijuana which comes in burgundy-colored spheres the size of BB’s.
“Well, slow down,” Roger said. “I used a whole bottle.”
“Really?” I mumbled as I shoved in another handful of brownie.
“That’s sixty tablets, you know.”
But I was oblivious. Sarah and Ryland went to work on the other tray of brownies and soon we were all fairly high — able to function, but in the zip code of fucked up.
By early afternoon, dinner was getting cold and most of the guests had arrived. Still no Danny.
Mark went upstairs to check on him. “He’s still breathing,” he reported, “but I don’t think we’re going to see him the rest of the day. He is out of it.” He clapped his hands, then rubbed them together. “Let’s eat!”
Danny and Mark had set up tables on their back deck, out in the open, and had enough chairs to seat twenty or so.
It was cold out, but space heaters and body heat warmed us, and we enjoyed the stark sunlight and mountain view. We all held hands as Mark led us in grace, then we started the circulation of the dishes, including a platter the size of a Goodyear on which Nicole had rendered the huge turkey into neat slabs of white meat.
Of course the dinner was perfect. Danny was a superb cook and everything was delicious. He was inside, passed out on his bed, missing the appreciative mass of friends and family enjoying the fruits of his labor.
I collected compliments on my artery-clogging casserole. I wanted to impress Danny with it — still in that eager-to-please new son-in-law period — but he was, according to Mark, unlikely to wake.
I was next to Nicole, with Savannah on her other side. Sarah and Ryland faced us from the opposite side of the table.
Then my life stopped.
I became aware of the quiet. Everything stopped, but of course it didn’t.
Conversations muted. I looked at Sarah, who’d begun crying. Yet I could not hear her.
It was me; I’d gone silent.
But it wasn’t me; I was watching me, yet I was still there.
I was mute, stock still, face flushed.
I’d never seen Sarah cry so hard, not even when she was a baby. Ryland held her, but rather than burrowing into his chest for comfort, she watched me, her body jerking with sobs.
What followed was unspoken. There was no conversation, because we didn’t need words. I felt a presence.
Everything was burned out, like an over-exposed photograph. Only the high contrast remained. There was a strong, beautiful light and despite the chill of November in the mountains, I was warmed and cocooned.
Of course, there was light — a stunning beautiful light, more than the brightest sunlight, utterly enveloping.
Come. There was no voice, but I heard it.
I can’t. Whatever it was, it heard my thoughts.
Yes.
No. No. I can’t.
But it’s time.
I won’t leave; not now.
Silent negotiations continued.
There was no time. Everything had stopped. I had no idea who or what I was talking to.
I felt a sudden determination to push back. This is not it, I said without speaking. I’m not finished.
I refused to leave. I looked across the table at my firstborn, heaving with sobs. And I thought of the little one, tiny as an acorn, in the body of the woman next to me. I turned to Nicole. Unlike Sarah, her face showed no concern. Neither did Savannah’s, but after all, she was five, chowing down on my life-changing casserole.
I turned to Nicole. In a calm steady voice, I said, “I think I’m dying.” I put my hand on my chest, figuring if I covered my heart, it would soothe its pain. Its pace was accelerating, like a roaring engine.
“You’re not going to die,” she said.
“Please.” Remarkably, still calm. “Call 911.” I was determined to push back. Maybe this voice or this presence was a test. Maybe my commitment to life was being tested and I needed to show how I could or would respond.
“We don’t need to call 911,” Nicole said. She looked annoyed, not concerned.
Come. It was a persistent presence. If the presence had a gender, it was female, kind but firm, like a teacher. But I pushed back. Still, there was the message: It is time to go. Do as we say. Let it all go.
No, I won’t. I know you want me to, but I can’t. Not now. I can’t leave them.
Part of me was stunned by the simple beauty of what was happening, that I was in negotiation with something or someone — this presence. Was this an angel? Was I pushing back on an angel? For a person of wavering faith, I found comfort in this, even though I was fighting against it.
I gripped the arms of the wrought-iron chair, scooted back and pulled myself up. The noise of the chair on the back deck sounded as if it came from blocks away, not beneath me.
Sarah was still crying. “Call 911,” she told Nicole. “Can’t you see he’s dying?’
“He’ll be all right.”
I stood weaving for a moment, then the sound of the other conversations on the porch resumed, as if someone gradually turned up the volume. I slid open the screen door and staggered into the living room. The rest of the guests out on the back deck were unaware I was dying.
I crossed the living room like a deckhand on rough seas, and collapsed head first in the half-bathroom next to the fireplace. I was face-down on the rug, my lower half jutting into the living room.
I flashed back to childhood: When I was a little boy and felt sick at night, I’d poke my father awake, inform him of my condition, then crawl into my parents’ bathroom and curl up on their rug for comfort. Something about being so close to my mother and father, on the warm green terrycloth rug, made me feel secure and invulnerable.
Wonderful symmetry, I thought, as I burrowed my nose into Danny’s terrycloth. I begin and end on a bathroom floor.
During long pockets of silence, the laughter from the guests out on the back deck disappeared. It didn’t, of course, but for me, all sound was gone.
I continued my silent negotiation with the presence that had come for me. I expected death at any moment.
Someday, I argued, I know it’s part of the deal, but not now. Please — not now. I can’t leave them. I need to get the children to adulthood. And now there’s my acorn, and that acorn is going to need me.
Later, Nicole and I argued about this. I contend that I died and came back. “You’d just never been that high before,” she said. But I’m certain that I died and talked my way back into living. I made a deal to buy more time.
How else to account for my hour bathed in stark, white light? It might have looked as if I’d passed out on the bathroom floor, but that wasn’t me. I wasn’t there. I was away, negotiating for my life — for more of it, at least.
I gradually came back but didn’t move, so comfortable was I in my terrycloth cocoon.
Like a good boyfriend, Ryland carried Sarah upstairs and held her hair back while she bent over the toilet, vomiting. Savannah appeared at her side, in her red party dress.
“I think Daddy’s dying,” Savannah said.
“In that red dress, she looked like the devil,” Sarah told me later. She also told me that she believed I died. She said I’d turned white, my eyes emptied, and that I left. She could feel me leaving and was certain she was watching her father die. That’s why she’d burst into tears.
Back on the floor of the bathroom, with my ass end sticking out into the living room: I couldn’t move, but I could hear people arrive:
“Happy Thanksgiving! Where’s Danny?”
“He’s passed out upstairs.”
Then they’d see my fat ass sprawled in the living room. “Who’s that?”
“That’s his son in law.”
The blessing here was that Danny slept through until the next morning. He didn’t witness this episode or the prolific vomiting that followed. Small blessings. He did, however, miss the casserole.
Was that death, a quiet slipping away into nothingness, bathed in bright light? As I rode the train home that night after hearing those three little words, I remembered dying, and what it felt like.
Was life just a cruel joke — a pleasure palace until it’s suddenly taken away? I remembered that quote from Richard Farina: “When you’ve walked a little with death, you learn to court it, play with it, defy it if you choose.”
I hadn’t walked with it, but I had negotiated with it in the shadow of the mountains. I don’t know that I won that argument, but the presence left and I remained.
It was the nothingness that worried me. What is it about death that bothers me? Probably the hours. To suddenly not be, for there to be nothing — maybe that was the real hell. The world would carry on and had it really mattered that I’d been here?
I’d be just another ex-parrot. I’d procreated and my children would remember me and, I hoped, miss me. As a teacher, I hoped I’d affected some people along the way, but probably most students thinking back on their college days wouldn’t remember my name.
So death was on the seat beside me. It came for me a second time. As I faced it, I feared the nothingness and the eternal void. I would be gone and who knew, beyond the beautiful light, what awaited.
If I pulled my intestine from a hole in my body and stretched it out, it would reach 20 feet in front of me, maybe more. This is the length of a more-than-respectable gain by a running back in either pro or college. This 20 feet of gooey innards is wrapped up inside, crammed into my stomach cavity, like Pillsbury poppin’-fresh cinnamon rolls ready to explode from the tube.
Larry McMurtry’s wonderful western novels include brutal torture scenes in which his cowboy heroes are captured by cruel Indians who poke a hole in the cowboy’s gut, pull out a handful of innards, then give the intestine’s end to a dog. The dog runs until the cowboy’s insides are outside.
That was the first thing that came to mind when I began hearing about the surgery that awaited. It was my intestine, after all, that was the root of my problems.
Near the end of my intestine was a puckering piece of flesh called the rectum. It’s the emergency exit for all the horrifying stuff my body expels.
A week after the train-station phone call from Martinez, I was in the multi-specialty clinic of the Dana Farber Cancer Center in Weymouth. A lot of the big hospitals are in Cambridge or in the Longwood area of Boston, so I lucked out that Dana Farber had a center adjacent to South Shore Hospital, and that it was affiliated with the Brigham and Women’s Hospital. It was 20 minutes from home and no freeway traffic.
I remembered some of those tales of hospital hijinks from my days in Florida — about the medical team that amputated the wrong leg or the healthy ballplayer who’d gone into the hospital for an ACL repair and came out dead.
At least if I had to get cancer, I got it in a great city for treatment.
Growing up in a medical family I was always critical of doctors other than my father and brother. I admired Dad and Charlie and knew how much they cared about their patients, but I rarely saw that level of concern in other physicians. They might smile and mouth the reassuring words, but they practiced what Nicole called “protocol care”: this is how we do it for all patients. They treat symptoms, not people. They didn’t seem to listen to patients much at all.
As I settled into the waiting room for the multi-specialty and breast-cancer clinic, it struck me that I was a member of the club now: a cancer sufferer. You could easily spot the breast-cancer patients: women in pastel turbans to cover their hair loss, frail but smiling.
As I looked around, I imagined the backstories. There were husbands there with turbaned wives, some turbaned women alone, some hale-and-hearty women sitting next to visibly shrunken men. Was that my future — wasting away? I always look at the upside: hey, maybe I’ll finally lose some weight.
Next to me, Nicole sat scrolling through her phone, always looking for stuff about midwifery or Kardashian-related news items.
A nurse took me to an examining room for my vitals. When I got on the scale, I told the her, “I know you have to do this, but I’d really rather not know that figure. Please don’t say it aloud.” It was the Aunt Edna approach to weight control.
She smiled, then led me to another exam room across the hall. “Dr. Corwin will be in in just a minute,” she said. Nicole and her phone were already seated along the wall. I’d barely gotten settled when Dr. Corwin walked in. He was probably mid-forties, with one of those faces that you can’t conjure ever being angry. He had smile lines and spoke from the side of his mouth, apparently well-practiced from a lifetime of Groucho Marx asides. His hair was short and immaculate. I might’ve thought it was painted on.
“Christian Corwin,” he said, shaking hands. It was a good grip and I looked down. Pretty soon those paws would be inside me. He pulled up a chair and leaned back. We commenced the getting-to-know-you sniffing period. Mostly this was to find out what we did for a living, where do we work, the usual pleasantries.
“I’m a home-birth midwife,” Nicole said.
“Really? That’s cool.”
That was not the usual response Nicole got from doctors. Most felt threatened by the continuing ascendancy of midwifery and dismissed her with skeptical scorn, though they usually stopped short of calling Nicole and her kind sorceresses. Instead, Corwin seemed genuinely intrigued, which got her attention.
“You know,” he said, after listening to her talk about her training. “It makes so much sense for majority of births to be done at home. Why go to a hospital to give birth? It’s not like you’re sick.”
For the first time that day, she smiled. “Exactly,” she said.
“My wife and I wish we would have had a home birth.” He shrugged. “I mean, you’d think I could handle it, but my specialty is with the other side.” He looked at me and the both of them laughed, my ass an apparent object of mirth.
Nicole did most of the talking. Her midwifery training made her skeptical of most physicians and she grilled Corwin, but he didn’t turn defensive.
“So what is your experience?” she asked.
“Good question,” he said. “Folks do need to know more about these people who are going to cut on them.”
He’d grown up in Connecticut, gone to med school at UConn, and done a residency in Minneapolis. He’d also been a Navy flight surgeon and had been stationed in Guam and the Middle East.
“Flight surgeon? My dad was a flight surgeon. Air Force, of course.”
“Really?” Corwin acted like I’d just told him he’d won the lottery. He asked about my father’s background, where we were stationed, where he was trained, how hard he worked.
“I remember in high school, after dad went into private practice. We’d all get ready for bed, then around 11 the phone would ring and I’d hear Dad go downstairs and back to the hospital. Sometimes, he was just getting home when I was getting up for school. I don’t know how he did it.”
Corwin’s smile was gone. “Did you resent it — him being gone so much?”
“Oh, no, not at all,” I said. “I was so proud of him. He’s been dead since 1974, but when I go back home and people hear my name, they ask if I’m his son. They get all teary-eyed just talking about him.”
“My children are little,” Corwin said. “You worry. I do, at least. Seems I’m gone a lot.”
“I was nothing but proud.”
We talked some more and I began to feel that the real doctor’s appointment must be some other time. We’d been there nearly an hour and we were still doing the get-to-know-you stuff.
“So — after the Navy,” I asked. “What brought you here?”
“One of my buddies settled in a little town around here and suggested I join this place,” he said. “We have a surgical group outside of here too. So we moved here and now he’s my partner and my neighbor.”
“Oh really — what town?”
“Cohasset.”
“We live in Cohasset,” Nicole said. “Who’s your friend?”
“John Froio.”
“Holy shit,” I said. “He’s our boys’ baseball coach.”
As millions have done before us, we paused to marvel at the smallness of the world, then Corwin offered his friend a figurative whistle of admiration. “I don’t know how he does it,” he said. “We’re pretty darn busy here and yet when he leaves, he tells me he’s going straight to the ballfield to coach a game. My kids are still little, but I don’t know if I could do what John does.”
As we entered Hour No. 2 of the visit, Corwin changed his tone a bit. It was time for business. “So let’s talk about this tumor,” Corwin said. “I don’t want you to be discouraged. This is going to be a long road, but we can do this. You can do this. Trust me.”
I did, of course. I’d rarely met anyone with such confidence who did not also reek of arrogance.
“Let me tell you what’s going on here.”
Mine was a common cancer. There was somewhere in the neighborhood of 140,000 new cases reported every year in the United States. I was a little younger than the usual colorectal cancer patient, and Corwin spun this into a good thing: they caught it when I was young.
Assuming the notes he’d gotten from Dr. Martinez were accurate, he offered the probable scenario. First of all, he needed to do his own exam and promised to have his hand up my ass within the hour.
“And it’s not like that thing Dr. Martinez used,” he said. “Those guys use flexible instruments, kind of like one of those foam noodles you see at swimming pools. I use a thing called a proctoscope and it’s solid; it’s not flexible at all. But I’ll make it as painless as possible.”
First, they had to be sure what I had — was the cancer in my lower colon or was it in my rectum. He’d need his exam to figure that out. The location would not affect the treatment, which would come in stages. I’d have chemotherapy first, and for that I needed to see another doctor — Doctor Freighter, I think he called him; sounded like a stevedore comic-book hero. We’d do that treatment for a couple of months, and Freighter was in charge. There’d also be daily radiation.
“It’s different for everybody,” Corwin said, “but the one thing all patients have in common is they hate it. “You’ll feel like you’re carrying a car on your back or you’ll be puking . . . it’s different with everyone.”
“Will I lose my hair?” I ran my fingers through my magnificent locks — graying, though otherwise impervious to the march of time.
“I doubt it,” he said. “We’ll be aiming all of that nasty radiation down there.” He looked down at my waist. “Don’t know if you have a lot of hair on your back or your butt, but if you lose any hair, it’ll probably be there.”
Nicole scoffed. “He’s like an ape.”
After my body recovered as much as it could from the constant — “and I do mean constant” — chemo and radiation, Corwin said it would be his turn.
The operation was called a “laproscopic directed low-anterior resection colonic, with a diverting loop ileostomy.”
“Okay?”
“What that means is that I’m going to cut out the tumor and then take some of your unaffected intestine — and there should be a lot of it — and make you a new butthole. That’s going to take some time to heal, so while everything’s settling into place, I’m going to take another section of your intestine and pull it out of a little hole I’m going to cut in your stomach.”
Jesus! I thought. It’s Larry McMurtry torture!
“For a while,” Corwin continued, “all of your poop will be diverted to this little bag and the bag will be connected to you right over that hole.”
“Do you, like, sew it on?”
“Good question. No, there’s an adhesive and it works pretty well.” He reached over and put his hand on my knee. “I know: it sounds gross, and sometimes it is. You’ll have accidents and get stool everywhere …” he shook his head “… it’s a mess. But I’ve done so many of these . . . I can’t even tell you how many. And nobody thinks they’ll make it, but they do.”
“Are we talking colostomy bag?” All I knew about those was a punchline from an early “Saturday Night Live” skit — Laraine Newman saying in a mock-sexy voice, “I know when I reach down and feel a warm colostomy bag that I’m with a real man.”
Corwin corrected me. “It’s an ostemy bag,” he said. “Colostomy means it’s permanent and your bag is temporary — God willing.”
“You mean it could be permanent?” he could see clouds move across my face.
“It’s very, very unlikely,” he said. “I can’t say absolutely no, because there’s always a chance that something could happen.”
Still: I’d apparently be walking around carrying a bag of my waste. Would I have to buy a whole new wardrobe?
“The good news is that eventually that will end,” Corwin said. “Like I say, four or five months, I get you back in the OR and we reconnect you. Ninety-nine times out of a hundred, it goes this way — you wear the bag for a few months, you heal, and then, after you retrain your bowels, you’re back to pooping like a normal person. If the cancer comes back, we’ll worry about all of this then.”
“How soon until you can get started?” Nicole asked.
Corwin roughed out a schedule for me:
I had to have an appointment with Dr. Freighter, the oncologist. Then there was Dr. Borgheit, who handled the radiation. And there was a woman named Marian Gilmore. “Her title is nurse-navigator,” he said. “She’s the one who keeps track of you and what you need to do. If you have a question, call her first and she’ll get the answer out of the rest of us.”
“Would she mind if I called her a bombardier instead? It reminds me of my happy childhood growing up in the Air Force.”
He smiled. “I’m sure she won’t mind.”
Nicole just rolled her eyes.
“So I’d say right after the holidays, we’ll get started on treatment. You’ll need to work with Freighter and his people to get set up.”
I’d hoped to fly home for a weekend to see my mother. She didn’t have much longer and I hated to think of her alone in the nursing home. But I couldn’t tell her I was sick; she would worry too much.
“Okay,” Corwin said. “Let’s get you to another room so I can get this exam over with.”
Nicole went back to the waiting area. A regular nurse — not a navigator or bombardier — took me to another exam room, told me to strip, put on a johnnie and lay down on the examining table with my ass pointed toward heaven.
Corwin came in carrying something that looked like a nine-iron.
“You playing a round this afternoon?”
He laughed. “Doesn’t look very pleasant, does it? I’ll do this as quickly as I can.”
The nurse held me in position as Corwin gently worked the uncomfortable metal tube into the heart of darkness. It was like Captain Willard going upriver in Apocalypse Now. I held my breath, fearing I would lose contro, loosing rodents and strange mythical beasts from my rectum. But soon it was over.
“You definitely have a tumor,” he said. “It’s kind of located right on the dividing line, right between the rectum and the colon.”
I slipped off the exam table and began getting dressed.
Corwin washed his hands, then dried with paper towels. “You’re looking at a long road, and I guarantee you you’ll get discouraged — maybe even depressed — but lots of people have been there before you. It won’t be easy, but you can do this.”
He stood at the door to say goodbye. “It’s too bad we had to meet under these circumstances,” he said. “It’d be much nicer to meet over a beer.”
It was late afternoon when we left. The boys would be home from school now, but Savannah was there to watch them. We stopped at a little tavern near Dana Farber called the Broad Street Diner. We had been too nervous to eat earlier, so she ordered a burger and I got a big bowl of clam chowder.
“Look, I’m sorry about all this,” I said.
Nicole shrugged. “Don’t apologize, except maybe for not taking better care of yourself. If you’d done what I said, we might not be here now. But we can’t change it now. Your doctor’s right — you’ll get through this.”
“I know,” I said, “it’s just so soon after your mother ….”
“Yes,” she said. “It is.”
I’d say we ate in silence for a bit but it’s a Boston bar, which means that the other customers were discussing the intricacies of the New England Patriots defense at top volume.
“Listen,” she said. “You’re more than this. Don’t give your life over to this. Don’t let cancer define who you are.”
It had not occurred to me that I would, but I nodded. It was probably the best advice she ever gave me.
“I won’t. Promise.”