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.