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My Death Odyssey

Robert Dailey

THERE SEEM TO BE four subjects that folks are reluctant to discuss with acquaintances, friends, intimates and often themselves: money, sex, religion and death. A few months ago, I broached the subject of money, to wit, my investment history—territory well-trod by this readership.

I will now turn to the literal and figurative last item in the above lineup of forbidden subjects: death. As a physician, I have some knowledge about the death of others. But I’ve had no experience with my own death—until now.

My health news has always reflected a “bullet-proof Bob.” Over my 88 years, I’ve had the most unlikely run of incredible good health: no serious illnesses, no broken bones, a single missed day of work thanks to the flu 45 years ago, a single significant surgery involving a knee replacement, no cancer or vascular disease, no hospitalizations, and an astonishing family history of longevity.

This incredible run ended with sudden finality. Two months ago, in preparation for a procedure for an enlarged prostate, I had a prostate-specific antigen (PSA) test performed. It was off-the-charts high, with a score above 1,000. At that moment, in the blink of an eye, I knew I had metastatic prostatic cancer (PC) and that it was incurable. So began my odyssey.

After due diligence—reviewing the disease online at some length—I got lucky. A friend put me in touch with a colleague of his, a professor at a large academic center who was an expert in metastatic PC. This expert pointed the way. I had my roadmap.

The most significant and revealing test was a PET-CT radioactive isotope scan of my entire body. It accurately identified all of my prostatic metastases down to the size of a pea. It revealed extensive cancer involving almost all my internal lymph nodes, head to toe, but only a few small scattered bone metastases, and no organ involvement at all.

My reaction to this news was confusion. How so? For some time, I had been ruminating about my future decade as a nonagenarian. My vision of it filled me with considerable apprehension and anxiety. With my wife’s health quite fragile, I saw the odds favoring her demise before me, leaving me spouseless and alone without intimates or family nearby, since I live in Mexico.

My deafness is now profound and a source of social isolation, anxiety and severe disability. Worse, the next decade would see an inevitably increasing frailty, physical deterioration and fading cognition, all impacting my ability to care for myself and enjoy daily life. I have seen this process up close both in my own family and in my medical practice.

Worse still, I couldn’t envision many practical steps that would significantly alter this future. A lot of happy talk surrounds such issues in the public press. The realities, I think, are a poor match for such talk. Ahead of me lay a faded old man waiting for an uncomfortable death.

On the other hand, the case for a somewhat different aging scenario could be made. I have been entirely symptom-free. PC is frequently a quiet fellow who creeps along silently in the shadows, not drawing attention to pain or other symptoms. In my case, this lack of pain and other symptoms suggested a robust response to therapy and the best possible prognosis for metastatic PC.

I remain in remarkable health, enjoy life and have no other current diseases. Most important, I have a wife who truly loves and understands me, and who will willingly share and help me with the experience of dying. What few regrets I have had, I have set to rights as best I can. In short, my immediate future is relatively bright.

So, is the tolling I hear the knell of impending decay and death, or is it ringing in some comfortable years ahead? It seems to be both—some sort of cosmic Manichean happenstance. Of two minds am I. Should I embark on a treatment plan with probably tolerable side effects that offers prolongation of life into a feared old age? Or should I go without treatment, enjoy a life unfettered by medicine’s interventions, and accept a shortened lifespan? What sails to set to death’s foreign shore?

After some significant dreams, consultations with my subconscious, acknowledging my biases and listening—really listening—to confidants, I’ve decided on a middle way. I will take my prescribed medicines but pass on chemo, continue to assess my disease’s progress, weigh the treatment side-effects, and keep an open mind about changing course. Death has of yet only darkened my door. As his presence becomes more insistent and real, will I change my mind in some way? Life is ever-changing and fraught with surprises. What will it bring? Time will tell. Quien sabe? Vamos a ver.

And my “long-term” future? I have for many years believed in purposed lives, reincarnation and the soul’s permanence. That I will return to this earth many times to share lives with my intimates, in circumstances and roles different than in this life. And that such journeys will bring us closer to the perfection known as God. I arrived at this belief system over many years, not as a rationalization for death’s inevitability, but rather because it made sense to me, and my readings and experience supported it. Whether this belief system is valid, I will discover soon enough.

Robert Dailey is a long-retired emergency physician from California. He lives with his wife in the slow lane of Cuernavaca, Mexico, where he enjoys birding, investing, and travel with an assist from credit card miles and points. His previous article was For the Fun of It.

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