Death: Friend or Foe

Daniel Callahan, a pioneer in bioethics and noted author wrote, “Is death a friend or an enemy, to be acquiesced to or to be fought?” Nearly 25 years later, the answer to his important question remains elusive for both patients and health care providers.

Prior to my Stage IV cancer diagnosis in December 2015, I viewed death as a worthy adversary. One to be respected, even feared. For this high-profile, final opponent would appear one day to fulfill its destiny. Regardless of wealth or social status, “…in this world, nothing can be said to be certain, except death and taxes.”

Cancer’s rapid advancement over the past few weeks provided an opportunity for me to rethink my image of death. As I knew and expected, bone is one of the most preferential targets for cancer to spread. Unfortunately, I’ve also experienced that bone pain is very difficult to treat and tends to be resistant to opioids. For these reasons, among others, my quality of life has greatly diminished since cancer first spread to my bone around October 2018.

In reading a retrospective review about bone metastases from squamous cell carcinoma of the head and neck (SCCHN), I was quite surprised by the accuracy of some key statistics. For example, the time from primary tumor diagnosis to the identification of metastatic bone disease ranged from being present at the time of initial diagnosis to a maximum 3.5 years later. Time from identification of metastatic bone disease to patient death was no greater than 8 months.

My initial diagnosis of Stage IV SCCHN was relayed to me in December 2015. Three years later, cancer spread to my spine. If the time from identification of metastatic bone disease to patient death is no higher than eight months, then my expiration date should be somewhere around May/June 2019.

Friedrich Wilhelm Nietzsche, a German philosopher, was quoted saying, “To die proudly when it is no longer possible to live proudly. Death of one’s own free choice, death at the proper time, with a clear head and with joyfulness, consummated in the midst of children and witnesses: so that an actual leave-taking is possible while he who is leaving is still there.”

Today (Friday) represents the two-week mark for my current hospital stay at Memorial Sloan-Kettering Cancer Center (MSKCC). Fortunately, I’ve had several wonderful visitors including Lorie, Humphrey and my oldest daughter, Rosie.

Figure 1: Lorie and Michael Becker with Humphrey at MSKCC

After completing all three palliative radiation therapy (RT) sessions targeting the tumor next to my T8 vertebrae, I plan on going home this coming Monday. Today I had the second RT session without incident.

Assuming all goes well, we have already made arrangements for hospice to come to our house. They will help us achieve the following goals of their care: (a) to help relieve my pain and suffering; (b) to make possible a “good” death; (c) to help Lorie and our daughters; (d) to assist in the search for meaning.

39 thoughts on “Death: Friend or Foe

  1. Dear Mr Michael, such a profound post, which is much more than a profound post. You are writing with such balance of heart soul body and mind. I admire you a lot. You are giving us – readers – a great teaching. I can’t express how much I admire your moral strenght, and your family as well. Hugs and prayers from Italy. Forza e coraggio. Clara

  2. God Bless You Michael You have fought a good fight I am declining too from ALS I am hoping to see my great grandchild in August Sometimes the suffering makes living impossible but we have to keep fighting I believe we will see each other in heaven We will be pain free ❤

  3. Hi Michael. I’m hoping you find some relief. As a fellow SCC Stage IV cancer patient with bone mets I can perhaps identify with your pain a bit. It has probably been the most challenging part of my 5 year treatment. I hope you get home soon and enjoy your family and Humphrey. All the best to you.

    -Mike

  4. I am humbled by this post, Michael. I’m so sorry about what must be unbelievable pain that you’ve experienced. You continue to amaze me with your bravery. Blessings to you and your family.

    • I would like to say “Thank you” for your blog. It is just a wealth of information concerning HPV related cancer. You’ve done a great job of turning your diagnosis into a positive learning tool and shown that we are all here to make the best of our time allotted here. Be Well Sir!

  5. I know you have a plan, and you have always been realistic and clearheaded about what you’re facing and what you’re doing (at least insofar as you’ve shown to all of us).

    All of that said, if the time comes, I’d like to offer that in-patient hospice was a very very good thing for my late wife. The particulars of her decline were such that I could not adequately and safely care for her here at home through to the end, and the time came when in-patient was the best option, even though that really wasn’t her preference. Once she was there, though, she was far more comfortable, and very well cared for.

    So, at the risk of overstepping, my own personal takeaway from that whole experience was that in-patient hospice care can be a very, very good thing if the time comes.

  6. Dear Mr. Becker,
    I thankfully had my daughter vaccinated for HPV. Since following your journey, I’m so grateful I did. May the rest of your days be beautiful. Wishing you peace.

  7. Your blog has been an invaluable source of information and inspiration. Wishing you and your family all the comfort and peace you seek. Thank you for sharing your journey!

  8. You are a true warrior. 😘💔 I am so happy our paths crossed in this game of life. You are a true inspiration. Hang in there. -Amy ❤

  9. Michael….
    You speak freely of things most people in your situation only think silently about. Your wisdom about life and death helps many other deal with these issues.
    Your bravery speaks volumes about you as a person. I find myself looking for your posts. They are honest and strike the core of humanity. May your light continue to shine.

  10. Thank you for all you’ve shared. You’ve left a legacy and memories for your daughters and Lorie to look back on. Your positive outlook going through all your struggles say so much about you. While I’ve appreciated reading your blogs and following your journey, even though the outcome was what is happening now, I hope you know you, Lorie and the girls have been in my prayers ever since your diagnosis. I hope you have peace and joy and comfort for the rest of your journey.

  11. Thank you for fighting through the pain and suffering and writing. Your perspective is invaluable for those of us trying to help friends with similar prognoses and no doubt even more so to those so afflicted.

    • Michael, I am always so eager to read your blogs and posts. I feel like I’ve been along for the ride on your journey the past 3 1/2 years, and what a journey it has been. You were so accomplished before your diagnosis, and since then you have made a greater impact through your research and insight, which will be a part of your legacy.
      I am so glad through Carly, your third daughter, I had the pleasure of knowing you. May you go forth shining✨

      • Dear Jeanette, this quote of yours made my day! TY! “You were so accomplished before your diagnosis, and since then you have made a greater impact through your research and insight, which will be a part of your legacy.”

  12. You have touched so many peoples lives through your sharing of this journey. Not a journey easily shared but one you have done so eloquently. My prayers and thoughts are and have been with you and your sweet family. May peace find and surround each of you in the days and weeks ahead.

  13. In the face of your diagnosis you chose to spread awareness of the HPV vaccine as a means of preventing several types of cancer. Your words, and the lives that you have no doubt saved, will be perhaps the most important part of your legacy. You have faced every step of your 3+ year journey with grace and good humor and as an example to all of us. May you spend your remaining days at peace, in comfort and surrounded by the people (and critters) who bring you the most joy.

  14. Hey Professor. You are scholarly, incredibly passionate for the best care with patients, family and loved ones. You have inspired and touched countless souls who can benefit from your gifts. Thank you for instilling such passion, guidance, and sense of family to your friends, colleagues and complete strangers. May you and your family find the peace and comfort you seek.

  15. Mr. Becker,

    Thank you for all your help. My partner, Olivia, whom I wish I could have called my fiance, died suddenly at home March 7th from what I think was a sudden laryngospasm secondary to having a very sensitive larynx due to juvenile onset Recurrent Respiratory Papillomatosis. It happened so quickly there was no time to talk, not that she was even physically able to, let alone prepare a nebulizer treatment of racemic epinephrine before she collapsed. She was still in the m7824 trial and had just received her last round of drug as she was not responding well, yet her airway was rather patent. Perhaps it was pragmatism but just prior to her death we had ordered a medical alert bracelet and I wonder if she had some premonition. I still believe she was being selfless and didn’t wake me until it was too late. Everything was always managable before and nothing came close to this save for self limiting laryngospasm several years ago post op but this had no clear imputus.

    Olivia followed your blog and I bought her your book the week prior. I know she appreciated everything you wrote. I’m typing this on her phone after seeing the email notification. She too was an advocate for treatment of her disease, and the HPV vaccine. She was a fighter and never stopped researching options and new clinical trials and was a very astute patient. That day we were going to travel to Baltimore to discuss treatment with Avastin while waiting on a new trial in Boston. That week she was actively researching mushrooms and their documented effects on immune response. It’s hard to come to terms with how inopportune it all is.

    Death was never far from her mind in her 33 years of life. She wanted to find herself spiritually over the last year or so, so much that the priest at her funeral said she had “baptism by desire.” She was in pain, physically from arthritis secondary to the past trial with Pembro, intercostal pain from coughing, low energy from the induced hypothyroidism and mentally from all the years of wondering “why me?” I thought I could help her grow stronger and in many respects she had, she was very introspective and was reading many books on her struggle with PTSD.

    You mention a “good death” , she always talked about going out on heru own terms, but I don’t know if this is what she envisioned. While what happened was horrifying and panic stricken I can’t help but wonder if there was some thought in her final moments that at least she was with me and not alone. Personally that has been my biggest fear in life for as long as I can remember.

    You stated your “expiration” date which I thought was somewhat amusing as when we were emailed paperwork for the autopsy the email subject was frankly “expiration forms”

    I’ve been doing a lot of research these past few weeks which makes me question if our consciousness expires with our bodies. One delves into reading on quantum mechanics, string theory, dark matter, after death communication, and lucid dreams. I myself had a bereavement dream the night she passed which has shaken me to the core and has given me a lot of faith in the afterlife . I woke from a random bizarre dream and was in a state of lucidity. I envisioned the room I was in, could clearly see that I was lying on the couch where I was sleeping in reality ( note I’ve never slept here beforehand) but wondered why I couldn’t move. I felt that ESP feeling when someone is behind you in close proximity and was worried what it was, but then Olivia came into view and I was happy. I was able to tell her I loved her, she gave me a look as if she didn’t believe me, but her smile said otherwise .I could clearly hear her say ” I’ll see you soon” she turned to walk out the other door, I begged her not to go so she leaned over and kissed me. I woke up with such love and conviction afterwards .

    I apologise for the rant, but I can’t shake it’s probable agenticity. I don’t know your beliefs in an afterlife but if there is one where you share it with her please pass on my appreciation and love and that I also hope to see her soon. I hope she is at peace. I don’t know if I’ll ever receive more “signs” from her but I would like to. Something to think about with your family since I know it has and would help me continue on, it has been difficult without her.

    Thank you so much for your time (for it is fleeting in this world more than we can ever know.) I welcome your comments and appreciate your candor, you have my utmost respect.

    • Dear Nick,

      Your response to my blog post deserves much more than a “thanks for thinking of me” type of response. Please know that I will have more to say here, but for the moment know that you have touched me by sharing Olivia’s story. The fact that she too was on the M7824 study, followed my blog, started reading my book, etc. are a lot for me to handle. More in the near future, but thank you so very much again for sharing Olivia with us.

      Warmest regards and deepest sympathies,

      Michael Becker

  16. Your approach to this blog has been to teach. That contribution is valuable as we see an uptick in HPV cancers in middle-aged men accompanied with too little awareness and discussion. Sadly, as you have pointed out, the vaccination of young people against HPV is too low. Your blog is broadly helping on all these fronts. Personally, as a fellow HPV cancer guy, your writing has meant a great deal to me. We readers are “with” you in a strong sense and will remain so.

  17. Michael,

    As I read all of your postings these last few years, there has been so much learning about your disease, and also your bravery to be writing so candidly of all that you have been going through. Because of you, I pass on the info about the HPV virus to friends with kids, because of you, I see the real course of courage. Your writings have helped so very many people. May you spend all of your days in peace with all you love, and thinking about you.

  18. Michael,
    To say you are an inspiration is an understatement! Throughout your journey, you have educated and inspired so many people. I pray for peace as you continue on this journey. You, Lorie, and the girls are in my prayers.
    Love,
    Barb

  19. Mr. Becker,
    Your blog has been a comfort to me since I found it while researching my husband’s diagnosis in November. He, too, has HPV+ SCC that started in his tonsil. I read and re-read passages as he went through chemo and radiation comforted by the knowledge I gained. Thank you so much for your dedication to your blog that provides such insight to others. My prayers are with you and your family that you all will find peace and comfort as your journey continues. I promise that I will forever continue to educate people about this disease and pled with them to vaccinate their children.

    Deryn Cass

    • While sad that your husband and I share this cancer diagnosis, I’m glad that you were able to find knowledge and comfort via my blog. I only wish that I was given a similar roadmap for my disease, as I think that knowing what lurks around the corner can be helpful—even if scary at times. But please understand​ that the majority of patients with HPV+ SCCHN respond well to treatment and that my recurrence is somewhat rare. So please keep the faith and continue educating people about the importance of vaccinating preteen boys and girls, as this is the best/only option at the moment for future generations to wipe HPV from this planet. Thank you

  20. Mr Becker,

    I have followed your blog and have admired your courage and strength. You have always been included in my daily prayers. Reading your blog and praying for you everyday made me feel like I’ve known you already eventhough I’ve never met you.
    Thank you sir for everything you’ve shared.
    You are surrounded with lots of love and prayers from your extended family, the people who read, shared your blog all these years. You’ve travelled well sir, we all love you. We will surely miss your inspiring blog.
    Please also pray for all cancer survivors, my husband and I, to continue travelling in our earthly journey with good health all the days of our lives.
    May you find peace and comfort in the arms of our Lord. Have a peaceful journey back home, Mr Becker.

    Gina Mikulski

    • Thank you for the constant prayers! Of course I will reciprocate for all cancer survivors, especially you and your husband. I hope all of you find and embrace your “walk with purpose”—then share that gift to leave the world a better place than you found it.

  21. Michael, in the short time I have known you and your family, it is obvious to see how you all have left a profound impact on all you meet. Your wisdom, strength, tenacity and overwhelming love for one another has been a blessing to have witnessed.

    On these final walks of your journey, know that you have raced a great race, kept the faith and completed a fantastic journey. I would say, dear sir, that you have won this race called life. God be with all of you.

    A Neighbor

    • Thank you for the kind words, Shelly. I only wish you knew the “me” before being diagnosed with cancer. That person wasn’t sleep-deprived or experiencing moments of steroid-induced rage. He was far more “neighborly” and, well, just a different person. I’m glad that you somehow were able to see through it all, as evidenced by your post. For that, I am grateful. And I love your subtle references to my book title—especially winning “the race called life.” Continuing the analogy, I can clearly see the finish line and people cheering me on, and it is beautiful. Thank you

  22. Michael…I read your post several days ago, but it left me so speechless (quite unusual for me!) that I could write no comment. I can only say that I, personally, feel so very honored to receive the gift of your thoughts and feelings as you navigate this intimate and most profound journey. We will all approach death one day and your guidance helps each of us who has the privilege of sharing in your journey to, perhaps, embrace our own deaths with greater courage and with deep intention.

    Thank you.

    • I often look back to the day that I first discovered that suspicious lump on the side of my neck. Once I found that it didn’t show any of the typical signs of infection, I knew in my heart that it was cancer. Further, I knew it was advanced cancer and how my story would likely end. Armed with this insight, I was able to focus on what I wanted to accomplish before I died. Many days of quiet introspection were precious. I’m not alone. In looking at other terminal patient’s blogs and other writing, it seems that a lot of us reexamine and emphasize what we value and reconsider what is important to us. And you are correct—no one, absolutely no one, escapes death. However, few people accept this fate and even fewer make life changes as a result. I often hear other patients complain that they thought they had more time and weren’t finished leaving their mark on this world. This is why I feel so very blessed to have lived my life on my terms and to have been granted additional time to write a book, publish >100 blog posts, and even gather the strength to do several high-profile interviews and speaking engagements to help further raise awareness for HPV. None of that could have been accomplished alone, but there are too many people to thank by name, and I would hate to miss counting anyone. The closing line of your post comment is “spot on”—I hope by sharing my story that readers embrace their deaths with more courage and intent. But more importantly, act sooner rather than waiting to hear the phrase “you’ve got cancer.”

  23. Michael, sending you and your family love and hugs. You are amazing, and your words and thoughts have and will continue to help so many. Fond wishes, my friend.

  24. Michael, I have been following your journey for just over a year. My husband was diagnosed with oral cancer in August 2017. Your blog has both frightened and enlightened me on the disease and treatment and the toll it takes on the patient. You have brought much awareness to this disease and for this you should be proud. The misery you have endured will no doubt help scientists, doctors and patients in the future. You have faced this with courage and hope but yet not hidden your fears. You are a true Warrior. Don’t let the statistics determine your expiration date, you still have so much more to do. God Bless You Michael.

  25. In February 2018, a dear friend of mine was diagnosed with hpv throat cancer. In trying to educate myself in order to provide sensitive and caring support to him, I came across your website and have been following your story over the last 13 months.
    Thank you for all the education and insight you have provided to so many. Thank you for your advocacy work regarding hpv vaccine. Thank you for sharing so much of yourself. You are truly an inspiration, and you are a wonderful writer.
    I sincerely wish you and your family peace and comfort in the days ahead.

  26. It has been many years since we met at WH. I want to thank you for sharing your very personal journey. You are a selfless advocate and educator. Your words and the love of your family (and sweet Humphrey) have touched so many. You are all in my thoughts daily and I wish you peace, comfort and love. God bless you Michael.

  27. Hi Michael,
    While I have read all your posts quickly upon the notification, I am just this evening reading all the follow up comments. How amazing that despite all the limitations this diagnosis brings with it, you have continued to Communicate flawlessly throughout each stage in your “walk with purpose” so that many others may glean insight into how being diagnosed with cancer does not delete your ability to be impactful on your family, friends and the larger community in a very positive way! Your final bow will be one which while certainly bringing lots of tears, will also bring a standing ovation for all that you have achieved.
    Well done❤️
    Many hugs to you, Lorie and the girls
    Amy

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