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Bill was my younger brother by four years. Most of our early lives together he looked up to me in a type of hero worship as I taught him what little I knew about life. Our relationship matured through the years but we remained very close friends, sharing our failures and triumphs, our joys and sorrows, on a regular basis.
As I watched Bill die at age 56 from the ravages of bladder cancer that had metastasized throughout his body, I never dreamt our earlier roles would be reversed and he would teach me so many important lessons about living. Of course, along the way he also taught me about dying. About how to endure hellacious pain with grace, never once giving in to the urge to lash out in fear, anger or frustration at those providing his care. About how to accept graciously and without complaint the almost unthinkable indignities that accompanied his disease. About never whining, “Why me? Life is so unfair.” About being focused on the people around him instead of on himself. About showing kindness and consideration to every person who entered his room to change his soiled bedclothes, to reposition his pain-racked body, or to talk about what it meant to die.
For more than twenty years before his death, Bill had been a dedicated power-lifter. He had a gym in his basement filled with equipment, including sets of dumbbells from 5 pounds to 70 pounds, free weights, and several complicated stainless steel contraptions that looked like medieval instruments of torture. He wasn’t a body builder, eager to show off the size of his biceps or his pectoral muscles. He was much too reserved for that kind of display. His goal was to be strong, to be in shape. And he was. A real hard-body. But he never bragged about it and seldom mentioned it, even to his close friends. He was, first and foremost, a very private man.
As Bill’s disease progressed, he was forced gradually to give up his beloved weight training program. He fought it with a fierce intensity, refusing to quit outright. When the cancer spread to his pelvis, he had to discontinue all the exercises that required him to squat or stand. Until, finally, all he could do was sit and use dumbbells to strengthen his arms and chest. But then the ever increasing pain that radiated through his body forced him to put the weights down for the last time. Yet, he refused to be defeated by the cancer. He continued to think of himself as a power lifter, a strong man who was able to face harsh reality and make the hard decisions.
That’s one reason Bill’s oncologist told me that he survived longer than any previous bladder cancer patient in his group’s practice. Instead of the six to nine months he first told Bill that he had to live, my brother continued for three and a half years after initial diagnosis. He was indeed a fighter who never gave up, despite overwhelming odds and unimaginable pain.
When it’s a loved one who’s diagnosed with a terminal illness, we prepare ourselves for the idea and for the eventuality of death. But we are never ready for the actual process of dying. A process that frequently robs the person of dignity and even identity. Suddenly your loved one looks as though he were ninety years old and sometimes acts like an irrational, delirious stranger. In a matter of days the personality change can happen in front of your eyes. Until it is difficult to recognize the person he was.
But the indignities of death at the end of life do not define the real person. The pushing and prodding of well-meaning strangers. The “accidents” that have to be cleaned up. The drugs that rob you of alertness and cognition while cloaking the always present, always terrible pain. In my brother’s case, his final weeks were full of indignities that were painful to watch. But through it all, Bill kept his personality. I want to share a little story about Bill that should tell you a great deal about him.
When he was at St. Joseph’s Hospital and then at the Jewish Center for the Aged, he was placed on a morphine drip. After a few days he became confused and delusional. It was an awful thing to see and even more terrible to hear that he had to be sedated several times during the night because he became violent. Because Bill was always a gentle man.
One night after he had been brought to the Jewish Center, I was sitting next to him, trying to provide what little comfort I could. He grabbed my arm and said with fierce intensity, “I’m not psychotic. It’s the morphine.”
Naturally, I believed his physicians had ordered the best drugs to manage the awful pain and I sadly thought that my brother was confused and irrational. Two days later Bill purposely pulled over the morphine drip apparatus and broke it. And after it was replaced he broke that one. When they put the third out of his reach he bit through the plastic IV tubing carrying the morphine to his arm. Twice. So in desperation they discontinued the drip and gave him a different form of morphine by mouth. Within 24 hours Bill was no longer psychotic, delusional, or confused. He had had what doctors call drug-induced psychosis. He had known what was wrong but no one would listen. Not even me.
Before being stricken with cancer, Bill was a kind, gentle man. It’s a great tribute to his strength of character that he continued to exhibit those qualities until the moment he slipped into the unresponsive state that immediately preceded his death. His dry but well-developed sense of humor also never deserted him. About a month after he was admitted to St. Joseph’s Hospital and then transferred to the Jewish Center for the Aged, my son, David, visited Bill. As they were talking, a young, very attractive, curvaceous blond nurse strolled by. David took one admiring look and said to his uncle, “Wow, is that the nurse who gives you the sponge baths?” Without blinking an eye, Bill dryly replied, “No chance, it’s the ugly one.” And on the second last day of his life, when his twenty-year-old daughter, Natalie, kissed him and said, “Dad, I love you,” the smallest of smiles flitted across his horribly emaciated face. At once he repeated those precious words to her. Then she pleaded softly, “Say it one more time.” So he whispered back in a voice barely over the threshold of audible sound, “One more time,” and chuckled so softly we couldn’t hear his laughter but all of us watching understood instantly.
Most people who knew Bill knew he had no patience for organized religion of any kind. Not even for the Catholicism in which we were raised. But it turned out that those lessons he taught me about dying were the precise lessons I needed to learn about living a full and Christian life. He did it without one word of preaching or without being aware of how deeply his example influenced me and every person who came in contact with him in the last weeks of his life. For those lessons I am forever grateful.
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