My Battle with Merkel Cell Cancer

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He is peaceful, tired, kind, and entirely unemotional.
Sent from my iPhone **
I was getting a lot more anxious. My mom was getting anxious as well, although both of
us began to feel an increasing split between the reality unfolding in front of us and the
reality as we wished it were. Dad was clearly preparing to die, and that was the objective
reality. The analytical Harvard-trained lawyer knew this, and he was the one drafting the
emails. The scared little boy watching his daddy suffer, watching his hero lose his last
battle, watching his role model pass in and out of consciousness, that scared little boy
believed that his daddy would make it. That scared little boy knew nothing could beat his
daddy, his protector.
Ultimately, both the lawyer and the scared little boy in me were right. Dad was dying, but
he was dying on his terms. Merkel Cell Carcinoma wanted to torture him into the
darkness, to chase him scared into the wildness of death. He stood his ground as long as
he could, then metaphorically said "fuck you, cancer, I may not be able to stop you from
hastening my death, but I'll be damned if I let you dictate how, when, and with what
degree of pain." Dad was a doctor, and a good one at that. He knew he had pneumonia,
and he was bringing up morphine, a respiratory depressant (like hydromorphone, trade
name Dilaudid). He was unable to dictate the terms of his entry to the world of cancer, but
he had just laid out the path for his exit. There would be no horrific final days of pain and
suffering.
My brother Michael wrote back at 1:36 (4:36 in Philadelphia, where he lives) "I wish him
good luck. Bon voyage, dad. I love you." Reading that, from my youngest brother, made
things even more real. We were really all saying our goodbyes. The rational part of my
brain was holding out hope even as I knew hope was fading fast.
They were ready to move him to the ICU, they had his room, but the doctor with the
paperwork was busy with another patient. We waited quite a while before he was moved.
** Email: Date: Wed, 18 Apr 2012 13:46:13 -0700
Subject: Update 13:46
Dad about to be moved to ICU 12 on the B side
Sent from my iPhone **
Before they moved him, they wanted to do something about his oxygen saturation. It
turns out that while he refused intubation, he accepted a "BiPAP" mask. This is a mask
that covers the nose and mouth and when it detects the patient breathing in, it ramps up
the pressure to force in the air. It also allows oxygen to be intermixed with the air, up to
100% oxygen. My guess is that dad knew dying from pneumonia would be horribly
painful, emulating drowning in some ways. The BiPAP mask may have been his way to
avoid some of that pain. Unfortunately, it had two huge drawbacks. First, dad's glasses
wouldn't fit with the BiPAP mask on. He had trifocals, and while I could get them in place,
they were slightly off in height, just enough to be non-functional. I later learned that they
could have fit the BiPAP mask around the glasses (although I asked about it at the time
and was told no). Later that day I would rush out briefly to pick up my medications (in
case I had to stay overnight a few nights), my dad's PEG tube feeding food (he never
My Battle with Merkel Cell Cancer