The Last Party
When I learned of the illness I was startled, but not really shocked. At 68, and feeling good, I thought I probably had more time, but they were quite clear. Pancreatic cancer was very difficult to treat and extremely difficult to cure. The new health care laws had permitted me to sign up for the new provision in which the estimated costs of treatment for the first year, spelled out in the law, could either be accessed for treatment or 75% of that same amount could be used as assets to which you had rights to for whatever purposes you chose. I had thought quite carefully about this unusual provision at the time. At least I thought I had. My new changed circumstances did make hearing this news a little different than I had anticipated. I did feel immediately knotted up with uneasiness about what option I would choose. I had an obvious incentive to treat my illness as aggressively as current medical science would permit in hopes of surviving, or at least of prolonging my survival. But I also had an incentive not to avail myself of any treatment and in that way leave a generous gift behind for the people I loved most. My mind flooded with the slights and failures of my generosity in my past. I thought I might make some reparations for these failures and this compelled me to feel I ought to forego treatment.
Driving home from my internist’s office, I was entirely preoccupied with it. I had been able to save a bit during my working life, but it wasn’t enough to leave much for my kids and I knew neither of them would ever live near the economic level we had managed to support during our lives. Even more important, they would have a very hard time as things now stood in helping their own children get educated without incurring enormous debts. So I had plenty of incentives to take the money from foregoing treatment to help them out. But now that decision and its consequences were extraordinarily real, and the selfish wish to claw for even a few more moments fought like an old animal pinned into a corner. With only palliative treatment, which is what the law would permit with this option, my internist thought I would have four to six months of life left. I had thought it would be easier. I thought I would be older. I was still so young, at least in my own mind.
I had, in fact, felt certain when I had first considered this option, that I would, without hesitation, choose to die in a simple and uncomplicated way, and feel the satisfaction of leaving a greater legacy to my wife and children than I had previously thought possible. Now, of course, it was no longer so simple. There was surgery, my internist had told me. We went over it in some detail. We had been friends for a long time as well as having a professional relationship, something I was now very grateful for. I had few friends who shared this particular good fortune, and in fact, nearly everyone I knew was regularly lamenting that they were lucky to talk to their physicians for ten minutes. So Charles and I had chatted (could that possibly be the right word? But it is.). We chatted about my now tremendously abbreviated future for nearly an hour. The surgery for pancreatic cancer is breathtakingly ambitious and daunting. A significant portion of your upper abdomen is invaded though a massive incision and most of what they run into, they either remove or reduce in size. It takes a long time to recover, and you are certainly not the same person ever again. You can’t digest food normally, eat normally, have anything it seemed resembling a normal digestive tract, and various nutritional problems are likely to crop up. Even more troubling still is that the likelihood of extending your life is uncertain. Apparently it happens, but not regularly. Why would I want to put myself through all of this? How would my wife handle it while I was in this extended and uncertain recuperative period? And how would I?
Charles was as he always was: direct. I so appreciated this in him. “I wouldn’t do it,” he said. “I suppose I’d want to, but in the end, I wouldn’t I don’t think. I’ve seen too many people struggle along, perhaps getting another year or so, suffering for much of it, partially from the uncertainty, or from the physical insults. I just don’t think I would choose it.”
Charles actually asked me if I’d like him to drive me home. This was, I felt, extraordinary. I certainly wasn’t impaired and I don’t think he thought I was, but the gesture of human kindness was superb. As I think back now, I suspect it changed something profound at that moment, and began to allow me to really know what I wished to do. Of course I didn’t accept, although today, perhaps I would. Nonetheless, I was very moved and very appreciative I had a real physician; a man who was capable of looking at me clear-eyed, tell me the truth as he saw it, and want to stay by my side while I absorbed it. I’d trade a dozen brilliant surgeons for that quality.
Sally had known I was at Charles’ office, but she certainly had not suspected any more than I had that I would have an extensive evaluation on the same day, much less what that evaluation would reveal. So when I pulled into our driveway, I could only sit there for a few minutes trying to imagine what I would say to her; what she would say to me; what we both would say to the children and to our friends, and how we would digest the enormity of our choice. By the time I had gotten home, I had finally appreciated how fortunate I was to have these people in my life; people whose significance was so great that it allowed me to genuinely weigh my own private interests against their welfare, or what I imagined theirs would be, and know what I wanted. There, to my surprise, tears filled my eyes for the first time and overflowed quietly.
Sally and I talked for several hours, wetted each other’s shirts more than once and then went out to our favorite restaurant. Neither of us felt much like eating, but we had a drink and appetizer. When we returned home, my mood was surprisingly light. I think Sally had too, by then, begun to appreciate what had felt right to me several hours before. We agreed to sit with the decision without discussing it with anyone else for a couple of days, just to let ourselves live with it.
We both took the rest of the week off from work and went down to Martha’s Vineyard, which is both beautiful and relatively quiet in mid-October, and is a place where we both feel at peace. We talked, and also spent time not talking, walking on the beach or wandering through town. For me, there was much savoring of the remarkable experience of simply being alive, and I wondered at how much time had passed through my days in this world without my really appreciating what an improbable gift living really was. Sally was of course, preoccupied in other ways, and I think my heart was heavier for her than for myself.
Returning home, I told her what I really wanted. I felt a settling within myself. A celebration. I wanted the equivalent of our wedding, with all our best and dearest friends in the world to visit so I could convey my love and appreciation that they had been with me throughout those years of living. I would be saying goodbye and we would share our sorrow at having to part, but I would be there! I would not be lying beyond reach, already cold in my casket, but I hoped fully alive and fully available to feel both the joy of having known them and shared some of our lives together, and our sorrow that this phase was drawing to an end.
Sally had to struggle with this notion. She had accepted, and quite gracefully and respectfully, my conviction that the treatment was an unreasonable and burdensome imposition on my quality of life, and perhaps in other ways, on hers. She had insisted I swear to her that I was not just giving up, nor being foolishly altruistic. I was not. She accepted it and from that time on, she was a superb ally.
The party was extraordinary; quite beyond anything I could have really imagined. Friends came. They came from everywhere and from all time. Friends from high school, friends from college and afterwards. Friends I had no seen for forty years or more. We asked people to ask others who might wish to come and they had. Our guests eventually numbered over one hundred, and nearly sixty more came as the kids’ guests. Borrowing a variation of New Orleans traditions, we had two bands. One was a small classical orchestra which played exquisitely sweetly, poignant celebrations of living. And in the later evening, a Preservation Hall type of orchestra played several dirges, and ended played triumphant swinging celebrations in their own style.
I was not very ill at the time of the party, although I no longer took much pleasure in either eating or drinking. But I was well enough to feel love, both from and for so many dear companions from my years in the world. There were tears to be sure, but fewer than you would perhaps suppose. I was not planning to die that night, and did not. But I was saying “Thank you and goodbye.” In fact, there was much laughter and more than a few people were courageous and generous enough to make toasts, both sorrow-filled and hilarious. Strange how these two can make such good companions, and how delightful it is. So I write to say goodbye now, not much afraid of going, and filled with gratitude for sharing this time with you.