This morning was much like all the others since she’s been gone. I feed the dog. Go out with him to greet the day. Smokey goes out to the backyard; I stay in the greenhouse. To the east there is an opening in the trees that has come to symbolize for me her path out of this life. Looking at it makes the sadness well up, the tears flow. I have no quarrel with the tears—putting a lid on the grief that drives them will only force it to erupt out of other channels.
But for weeks I struggled with what felt like a disconnect between my grief and her reality. The diagnosis was a surprise, to us and to our doctor. No warning signs.
Elizabeth had been living with knee pain for over a year. Specialists who looked at the X-rays said they saw some arthritis but not enough to explain her level of pain. An MRI revealed a bit of narrowing of a passage in the spine, possibly an amplifier of the pain. Exercises and cortisone shots were recommended. But neither kept the pain from steadily becoming more severe. Had the condition in the spine deteriorated? Another MRI was done.
Our doctor called. “Good news,” he said, “the back looks stable.” A pause. “We do see a small spot near the liver, probably nothing, but we should take a closer look at it.”
A CAT scan was done. This time the doctor didn’t call, an assistant did. She said he wanted to see both of us in his office. On the way there Elizabeth said, “I know what this is going to be. Cancer.” Her voice was steady, matter of fact.
“Could be something else,” I said, though I feared she was right.
We sat down in our doctor’s private office. He moved his chair so his desk wasn’t between him and us. “It’s not good,” he said. “Inoperable pancreatic cancer.” It was already two inches across and had spread to the liver and stomach lining.
A silence. He looked at me. I looked down and away. She was sitting up straight. “How long do I have, two months?” she asked. No waver in her voice.
“Probably more,” he said, but it wasn’t possible to be specific.
“OK, two to six months,” she said. Another silence. Our doctor’s first name is William. “I’m going to call you Bill,” she said, “is that OK?” He nodded. A hint of a smile said he didn’t mind at all.
“I’m going to steer the course of this thing,” she said, “with your help.”
“You’ll have it,” he said.
She went on to tell him why she wasn’t going for chemotherapy. She knew others, both friends and patients in her psychotherapy practice, who, in similar situations, did opt for it. “It may prolong my life,” she said, “but it will make all of it a lot more miserable.” He said he respected her decision.
On the way back from his office neither of us spoke for a while. Then she said: “I had some nightmare scenarios. My knees putting me in a wheelchair. Or descending into dementia, like my brother. This may be a better way of going.” A pause. “I know what’s going to happen. I’m going to lose a lot of weight. It will be quick. If there’s a lot of pain toward the end, I want you to make sure I have all the pain meds I need.”
She then went on to talk about all the things that needed to be done soon. Review and, if needed, revise her will. “I need to tell my patients I have to shut down my practice. They will be upset. I have to think about whether it will be better for them if it’s done over the phone or in person.”
We also had to break the news to family and friends. And to put in place reliable resources for end of life care. “I’ll need your help,” she said. “I’m worried about it taking a lot of time away from your writing projects.” I told her those could wait. It was hard for me to talk. She had just been handed a death sentence, and here she was thinking about the problems that might create for the people she cared about.
A week before she died she asked one of her dearest friends to write down and pass on to me what she wanted for her memorial service. Where it was to be held, the caterer, the poem—Wallace Stevens’s “The Snow Man”—she wanted read “by someone with a strong voice.” Children welcome.
She ran the show all the way to the end.
Was there a disconnect between my tears and her reality? Her journey out of this life was relatively pain free. Her knees continued to hurt but there was none of the cancer pain she had braced herself for. One night she said: “Here I am, dying of cancer, but it’s these stupid knees that keep waking me up. What a joke.”
And from its start her path was lined by the love of those who cared for her. These were reasons to give thanks to the powers or the good luck that helped things turn out that way. But whenever I found myself giving thanks for this turn of events my sadness would well up. Didn’t seem right to bring grief to a thanksgiving. The tears felt like intruders.
Until I recalled occasions on which, sitting by her bedside, I had to look away to give the sadness that had welled up a moment to subside. She would reach out and take my hand. She was touched by my tears, saw them as a measure of how much she meant to me. So, it is okay to let them come to my thanksgivings.
The sadness will likely be around for a while. Her absence leaves a big hole in my life. I can fill it a bit by keeping in mind a way in which she’s still present. If I care deeply enough about you in an unselfish way, the line between the “you” and the “me” begins to get blurred. My sense of who I am expands to enfold aspects of you. When we are separated, whether by distance or by death, that you in me is still there. I can talk to it and hear it talking back to me: Yes, good idea. No, I wouldn’t do that. Take care, my love.