Monday, September 5, 2016

An untimely death

"And I'll show you a young man with so many reasons why
There but for fortune go you or I.

My friend Tom died. He turned 62 in August. In other words, he was way too young to die.

I met Tom during my freshman year of college. I won't claim we were intimate friends. I'm an intovert and Tom is quiet, but we were both part of a larger group that spent four years of college hanging out. We played pool at the Old Stone Jug and had parties at Random House, the anti-fraternity group living house which was Tom's college home.

At the end of our sophomore year, I went on a canoe trip in the Adirondack Mountains with another girl and six guys, including Tom. We paddled, portaged, cooked over campfires, slept in tents and drank a lot of beer and Jack Daniels. You get to know your friends really well after a week without showers and other creature comforts.

Tom was a geology major and he moved to Houston for work after graduation. After a year or two, there was a group of us Colgate grads living here, drawn by the booming job market and low cost of living. And probably drawn by each other and our friendship, since we were not all tied to the energy industry.

As time passed and we aquired spouses and cats and mortgages, our little group of friends spread out across this sprawling city, from Katy to Kingwood to Jersey Village and later Sugar Land. Kids and jobs and divorces and life happened, but we still always managed to get together a few times a year. For forty years.

There is something precious about friendships with people who knew you when you were young, who've known you for more than two-thirds of your lifespan. You forged bonds in college, when you were still forging yourself. You may go in different directions, develop different interests, have different lifestyles, make friends with new people. You may not even have much in common any more. Ah, but you have history. You have shared war stories, collective memories, deep roots that intertwine. You may annoy each other, judge each other, but you also forgive each other. Because history trumps friendship derailers.

Tom bought a home close to town and kept it during a work rotation in Kazakhstan, where he met his wife and older daughter. Eventualy they moved back, remodeled the house, had a baby, and started a tradition of hosting holiday parties.

Last December we celebrated the holidays with Tom and his family for the 14th annual and final time.

I found out he was sick in December 2014, when I got this note.
A change of pace this year. Our annual holiday get-together will be at Café Zelko at 11th and Beverly on Sunday December 21 at 6 pm. See you there

Tom and Nina

p.s. Liz – give me a call.
When I called, he told me he had pancreatic cancer. I stupidly managed to say all the wrong things. For some reason my brain confused pancreatic cancer with prostate cancer, a much less ominous kind of cancer. I said, oh, my cousin had that, he had treatment and he's fine now. Then I told him all about our recent Hawaiian cruise.

Later I felt terrible. I sent him a note.
I apologize for rambling on about Hawaii and a lot of other unimportant stuff yesterday. I was in shock or denial (as well as being ill-informed) about your diagnosis. I've been feeling terrible about saying all the wrong things, for sticking my head in the sand and for being perhaps insensitively positive and optimistic. I'm not sure there is a right thing to say except that if there is anything I can do at any time, let me know.
He emailed right back.
No apologies are necessary. I didn’t even notice anything untowards. Thanks for your thoughts.
At the holiday dinner, he looked good and was in good spirits. At least that's how I remember it. I found this photo. Me, Tom, Midge, Wanda and David.
A couple of days later he sent an update, the first of those we'd get in the following months.
The pancreatic cancer has been confirmed but it is still at an early stage. I start chemo at M. D. Anderson on Monday. I will have 4 rounds – 1 every 2 weeks. Possible hair loss but the chemo is well-tolerated and I can probably work after a day or two. Surgery will follow. I’ll keep y’all updated.

We really enjoyed the dinner at Zelko’s. We’re still snacking on the left-overs. Happy Holidays, Tom
I wrote back.
Thanks for the update Tom. We will be thinking of you. Of course I am here and happy to help if there is anything at all that I can do. Remember, your friends want to help, it helps us to help you so do not hesitate to ask.

Thanks for the very lovely holiday party. We had fun and the food was amazing. After you recover from the surgery we'll all have to go out again to celebrate. Our treat this time.

Keep us posted please. Love to Nina and the girls.
A month later we got another update.
I’ve had two rounds of chemo and still no nausea or other problems except last week my hair began falling out in clumps. Rather than agonize about it, I just went ahead, bought an electric razor and took it all off. I’m scheduled for my next CT scan on February 13th and then they’ll decide what the next steps are.


p.s. - I bought a couple of hats too.

Each update was now being sent to a larger audience of old friends. Each one drew a volley of reply-alls, but I sent my responses to Tom only.
Glad no nausea - I'd rather lose my hair that be queasy! Hats will keep your head warm, and hair grows back.

Love you Tom. Keep up the updates. Neil and I talk about you often and hope you are doing OK.
Update number 3 was encouraging.
The chemo treatments are completed and the news is all good! The primary tumor is no longer clearly visualized, there is no sign of any spreading and the tumor markers from the blood work are back to normal.

The next step is surgery – the Whipple procedure (pancreatoduodenectomy). It is scheduled for March 9. I will be in the hospital for 8-10 days followed by about 8 weeks of recovery. There will probably be a follow-up series of chemo, just as a precaution. So far – so good.
We all wanted to believe, in the face of medical literature supporting a poor prognosis for long-term survival of pancreatic cancer, that everything would be all right. I wrote back.
Yay! Great news. I'm already planning the celebration party. Late May is looking good. Surgery at MDA? Happy for you! Love, Liz
Tom had surgery in March. His outlook was even more positive, based on the clinical findings.
I’ve returned home from MD Anderson today. Everything is still going well.... I’m on a low fat, low carb diet with 6-8 small meals a day. I tire easily and need to rest after about 20 minutes. Tonight hopefully I will be able to have my first uninterrupted sleep in 10 days.

I got the final pathology report this morning. It turns out that I didn’t have pancreatic cancer after all! Instead I had duodenal cancer. It’s a rarer cancer with a better outcome chance. The tumor was between the duodenum and the pancreas so the Whipple procedure was still the preferred procedure. My follow-up chemo will be using a different agent.

Thanks for all the best wishes and support.
I was happy for him, for all of us, his wife and daughers, family and friends.
Fantastic news Tom! Hurrah to being home and getting some sleep and rest! Let us know the chemo schedule when you know it. Talk to you soon. Love, Liz
The best news was also the last really good news.
Yesterday I had 5 appointments at MD Anderson. Basically everything is OK. My last tube was removed. I now have a whole variety of new and interesting abdominal scars. I will start a pill-based chemo regime next week for 4 months. It’s supposed to be milder than the earlier IV chemo. This is more of an insurance treatment as there is no signs of any tumors. I’ll have follow-up CT scans in 3 months.

My diet can slowly return to normal but I’ll be going easy on fats and fried food. With the removal of a big piece of my pancreas, I’m now a Type 1 diabetic and will be permanently taking insulin. Though this probably isn’t the best weight loss plan, I now weigh less than I have in 30 years!

Thanks for all of your best wishes, prayers and concerns. I’ll be going back to work next week.
I was ready to get the party started.
That is so awesome. As soon as you have a chance to see how you feel on the chemo, I'll call you to plan that celebration party. Think about the guest list and a nice place to go where you can enjoy the food.
The party had to be postponed. The next update was sobering. Tom tried to put the best possible spin on it.
Unfortunately my cancer is not gone. In early July, I went for my 4 month post-surgery CT scans and they found a small lesion on my liver. Last week I had an MRI and a PET scan. Yesterday I found out the results.

There is a small tumor on my liver and another small one in my peritoneum. They showed up on the MRI but not the PET which indicates that they are very small and localized (MRI has a higher resolution than PET). My doctors recommend that I have another scan in September and then probably begin chemotherapy. The reasoning is to "save" using the chemo until there is some growth noted.

While there is no cure nor a surgical option, the chemo can be an effective treatment. I had a bad allergic reaction to one chemo drug, but there are other formulations available. I will be getting a port for the chemo below my collar bone - tying into a vein in my neck. The schedule will be a treatment once every two weeks - continuing indefinitely. This is, of course, very disappointing.

Actually I’m feeling very good. I’ve lost a lot of weight and I’m much more active than before. My work schedule is flexible and I’m enjoying the projects I work on. In June, I went to a reunion of the descendants of my maternal grandparents in Savannah (there were about 50 of us) and that was a good time. In August, Tanya and I are off to another reunion with my brother and sisters and their families at a resort in western Pennsylvania.
I decided we need to start the party anyway.
Well, that sucks. I’m sorry Tom.

I am glad you are feeling good and enjoying work and summer activities.... If you are up to it, and it sounds like you are, I’d still like to host a dinner - sorry I have been remiss about planning it sooner. I was thinking about Labor Day weekend Would that work for you? ... It will be somewhere central, I have some ideas. Do you have any restrictions on any variety of ethnic food?

I wish we were celebrating something even better than effective treatment but we will celebrate your awesome positive attitude and drink (lemonade) to your continuing to feel well.

But I have to say it. Fuck cancer.
We met for dinner in early September at Pico's with our other Colgate friends, Tom and his wife Nina, Midge and her boyfriend Bill, Dave and his wife Wanda, Neil and me. It was lovely. The next update came a month later.
Well, I’m back on chemo again. This time there are almost no side effects. I still have my hair. The base line CT scans showed that the lesions had spread a little bit but the oncologists thought it wasn’t too bad. I have a chemo port below my collarbone hooked up to my neck vein. I don’t notice it much, but it is kind of weird.

I’ll get some new results towards the beginning of November. I’m feeling good and staying busy. Thanks for all your thoughts and prayers.
There wasn't much to say.
Seems like mostly good news. Midge and I were talking about you the day before you sent this, hoping to get an update soon. Thanks for keeping us posted.

I hope chemo continues to go well. If there is ever anything I can do to help, remember I'm just a phone call or email away - don't hesitate to ask.
Things continued on an upswing - but as he reminded us, this was not remission.
Hurray - I got my CT scans results and everything is "outstanding." All the nodes and growths have receded and some are no longer visible. This is very good news. My tumor markers from the blood work are also improving. I’ll continue with the same chemo regime for another 2 or 3 months and get another set of CT scans.

Even though this is encouraging, my condition is treatable but not curable at this time. I’m feeling fine except for the weird cold sensitivity in my extremities from the oxyplatin chemo. Just walking the dog this evening felt like 0 degrees on my nose, fingers and ears when in fact it was about 55. This will pass after 3 or 4 days.

Happy Thanksgiving.
It could have been worse of course. I was grateful.
Hurray hurray! This is definitely something to be thankful for Tom.

Love to everyone and Happy Thanksgiving!

Liz, Neil, Chelsea, Kandace, Ryland, Chris, Laurie, Luke, the various significant others, and the fur kids.
In December Tom hosted his fourteenth annual and final Christmas celebration.
We’re planning our annual holiday party for Saturday, December 19. We will be holding it at a restaurant again. We would like to get a head count before we make any reservations – so just give us a heads up by this Monday and we’ll get back with the time and location.

Happy Holidays.
After the holidays time sped up. In June, Tom and some of my other friends went to Colgate for reunion. I've never gone, for reasons that would take another post to relate.

In July Tom sent his first and only update of 2016.
I had been having high fevers, body aches and fatigue for about 10 days. On July 5 I was checked back into MDA. After numerous tests, it was discovered that I had a rare bacterial blood infection. I got out of the hospital yesterday and I might return to work tomorrow. My chemo regime will need to be rest. Feeling better now.
I had no clue how little time he had left. No one did, not even Tom.
Sorry Tom, that sounds like no fun at all. I'm glad your doctors were able to diagnose and treat it and that you are feeling better now. Take care of yourself, get lots of rest, I can't imagine wanting to go back to work - but you know what's right for you.
David and Wanda stepped up to host a Labor Day get together. Tom accepted, "provided I’m feeling OK."

That was on August 7. On September 1, Midge called to say that Tom had been back in the hospital. He'd become jaundiced. Tumors or scar tissue were compressing his bile ducts. A procedure to place drainage stents was planned but didn't happen. Tom's kidneys were shutting down. He was sent home for hospice care.

He was given anything from a few days to a few weeks to live. He asked for no visits or phone calls.

We spent the evening of Sept. 3 with Midge and Bill, David and Wanda, and a few other old friends who knew Tom.

Tom died in the wee hours of Sept. 4.

I've been preparing for this since I comprehended the seriousness of pancreatic cancer. From the moment I heard the words "tumor" and "liver" I knew he was on borrowed time.

We're all on borrowed time, but Tom's note had an acceleration clause. And now it's come due and the piper has called. And I have to say it again. Fuck cancer.

Happier days. Tom, Midge, David, me, Valerie, about 7 years ago.

Show me the prison, show me the jail
Show me the prisoner whose life has gone stale
And I'll show you a young man
With so many reasons why
There but for fortune go you or I

Show me the alley, show me the train
Show me the hobo who sleeps out in the rain
And I'll show you a young man
With so many reasons why
There but for fortune go you or I

Show me the whiskey, stains on the floor
Show me the drunkard as he stumbles out the door
And I'll show you a young man
With so many reasons why
There but for fortune go you or I

Show me the country where the bombs had to fall
Show me the ruins of the buildings once so tall
And I'll show you a young land
With so many reasons why
There but for fortune go you and I
You and I.

(Phil Ochs)

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Thanks for your comment! I will post it as soon as I receive it. Liz