"Take my life, but spare my son's"

She made a "pact with God" when her son was ill. When she became sick, the "contract" gave her strength to die with dignity and honor.

By Donald Fox, MD
Internist/Philadelphia

May 1997 marked an unforgettable anniversary for my family: Five years had passed since our oldest son, Robb, was diagnosed with a highly malignant sarcoma.

Commemorating that milestone, my wife, Kay, revisited Har Zion synagogue and silently repeated an age-old plea to God that she'd been raising for five years: "Mir fur dir. (Me for you.) Take my life, but spare his."

Ever since Robb's diagnosis, we'd lived in constant fear that his three surgeries and six weeks of radiation hadn't rid him of the cancer. Our emotions rose and fell with each CT and MRI. After every negative report, Kay returned to Har Zion to repeat her pledge. She always brought a cash donation, a token of appreciation to thank God for his benevolence.

Now that Robb had survived for five years cancer-free, he could finally be considered "cured." Other things were going smoothly as well—too smoothly, for us. My practice had been acquired by a major hospital network, my work schedule was reasonable, we had ample time for travel, and above all, Kay and I were both feeling well.

Then, in October, Kay began to experience headaches and neck pain. Her previously diagnosed herniated cervical disk could account for the neck pain, I figured, but she'd never complained of headaches before. When a small, hard lump appeared on the left side of her head a week later, I told her she needed a CT scan.

The next day, Kay went to the hospital for the scan. I waited two hours for the radiologist to read the films, then anxiously called the X-ray reading room.

"Dr. Fox, your wife has a growth in her skull. It doesn't look like it involves her brain. Hopefully it's a benign tumor. Sorry to have to give you this news."

Kay called a few minutes later. "Did you hear from the hospital?"

"No," I lied. "I'll call you as soon as I get the report." I just couldn't break this news to her over the phone.

When I got home and Kay saw my face, she knew immediately that I had bad news. I put my arms around her, hugging her as tightly as I could.

"There's a problem. The CT scan shows a growth on your skull. It's probably only a benign meningioma. We'll get it removed. Your headaches will go away. You'll be fine." Kay wasn't buying my optimism.

The next morning, we went to see a neurosurgeon. After looking at the scans, he echoed my opinion. "It may be a meningioma. Tomorrow, I'll remove the growth. Then we'll have a definite diagnosis. But first you need some preadmission testing."

Off we went for a chest X-ray and a bone scan. After learning that the chest film was normal, I went into the nuclear radiology reading room. A whole-body bone scan hung ominously on the view box.

I didn't need to have the radiologist tell me the diagnosis. Even from halfway across the room, I could see the dense black dots scattered throughout the skull, spine, collar bones, long bones, ribs, and pelvis. Never before had I seen such diffuse bony metastases. Fearfully, I asked, "That's not my wife's scan, is it?"

"Yes, it is," was the answer. "I'm sorry."

Courage in the face of long odds

Somewhere in Kay's body a malignant tumor had started, spreading its tentacles to involve almost every bone. I could only hope that the disease was treatable—a lymphoma, or perhaps a breast cancer that might respond to hormonal treatment or chemotherapy. I chose not to say anything to Kay until an absolute tissue diagnosis was established.

In the OR, the neurosurgeon cut away a wide segment of Kay's skull around the lesion. He placed the circle of bone in formalin to fix the tissue, then covered the defect in Kay's cranium with a template of plastic. In minutes, the excised bony tissue was on the stage of a laboratory microscope, where the hospital pathologist easily identified the mass of chaotic-looking cells.

Within the hour, the neurosurgeon walked into the surgical waiting area to speak with our family. "I'm sorry. Kay has a metastatic adenocarcinoma. We don't know where it started, but it's incurable." Kay was going die, probably soon.

What else could he say? The facts were incontrovertible. Barring some miracle, Kay had little time left. Some of us wept silently, some cried out in despair, oblivious to the other families in the waiting room.

We were all there when Kay awakened. She looked at me squarely, expectantly, "What is it, Don? Shoot straight with me." The tears in my eyes told her the news wasn't good.

Grasping her hand, I said, "It's cancer that's spread to the bone. We have to find out where it came from, so it can be treated." Somehow I still hoped it might be a primary breast cancer, potentially treatable. But Kay looked resigned. "I knew it," she whispered. Then she went back to sleep.

In her hospital bed later that night, she began teaching us all the meaning of courage. She reached for the telephone, and one by one, spoke with all nine of our grandchildren, ages 8 to 21. "Hi, this is Nan," she said in calm, reassuring tones. "I just had my surgery. I have cancer, but don't worry—I'm going to be fine. The one thing I want you to remember is that nothing has changed; I'm still the same Nan you always knew. Don't treat me any differently. I love you very much."

How do you function rationally each day while struggling with the torment of a death sentence? Somehow, Kay did. She never expressed fear or concern about herself—only about how her illness would affect our family.

The primary site of her cancer was a small tumor in the lower lobe of her left lung. The odds for remission, even a temporary one, were low. But for Kay, some chance was better than none.

The nightmare of chemotherapy and concomitant radiation began, with the attendant nausea, vomiting, poor appetite, and profound weakness. The big problem was the spread of the cancer to Kay's bones. A vertebra in her back had collapsed. The bone of her left upper arm had fractured, a doubly incapacitating problem because she was left-handed. Her bone marrow couldn't take the assault of chemotherapy and radiation; her blood count dropped, and she needed frequent transfusions. Yet Kay never complained. This was her pact with God—her "Mir fur dir."

Over the weeks and months that followed, the family gathered frequently to discuss our feelings. So many bridges were mended. It's hard to say that some good can come out of tragedy, but it did. Kay had never been aware of how much impact she'd had on so many people. The outpouring of affection she experienced was more than she ever expected.

I don't know which is better—to die suddenly, avoiding prolonged discomfort but sacrificing the opportunity to verbalize love; or to die slowly in pain, with many chances for loving closure. A tough choice, but in Kay's case, no choice: She would die with unremitting pain.

Kay set three goals. She wanted to survive long enough so that our granddaughter Rebecca's Bat Mitzvah would not be marred by her death. Likewise, she wanted her nephew Mark's graduation from college to remain a happy event. And because birthdays and anniversaries were so important to her, she wanted to make it to her birthday, May 18. No one thought her goals were realistic.

With the end nearing, Kay takes charge

Despite the megadoses of narcotics, her mind remained clear. But in early May, when paralysis began developing in her legs, it became obvious that the end was near. Kay, the meticulous organizer, began to prepare for her funeral.

The first matter of business: her coffin. A plain pine box; no fancy, finely-finished hardwood container for her. She dispatched our son, Andrew, to scout out the choices. Among the photos Andrew brought back, she found one showing just the coffin she wanted.

Next, Kay painstakingly picked the undergarments, dress, wig, shoes, and stockings she would wear to her grave.

As for the service, Kay was adamant: She wanted no eulogies or flowery references. Those weren't her style. We tried to change her mind, wanting the chance to express our feelings at the final parting. But Kay wouldn't hear of it.

Soon after, our rabbi visited her. Kay talked with him about how little time she had left in this life, and the infinite time her spirit would spend in eternity. She spoke with brave acceptance, shedding no tears—the final installment of her contract with God.

When the conversation gravitated to Kay's funeral service, the rabbi told her he'd direct his comments to the living, using words and thoughts to buttress her family's strength so they could face a world without her. His comments were so poignant and powerful that Kay agreed to a compromise: She'd allow eulogies, but only if she approved them first.

On Mother's Day in 1998, our family gathered at Kay's bedside. For some reason, she seemed unusually alert on her special day. But we knew we were running out of time; the ever-increasing doses of narcotics had left Kay with few lucid moments, and conversing with her had become difficult. This would probably be the last time Kay could preview our eulogies.

Her sister, Paula, read hers first. Kay nodded with approval. All our eyes filled with tears.

Our youngest daughter, Susan, read her eulogy. "We don't always talk much, but sometimes you pass me a wise, knowing smile. It speaks more than 1,000 words; it speaks a lifetime. You made me. You watched me grow. Most of the time, you let me be me. I wish we could talk again. I have so much more to tell you. I miss you already. But you will be with me, always and forever in my heart, thoughts, and soul." Kay nodded.

Robb waited for everyone to get their emotions under control, then read his eulogy. "A plain pine box and no eulogy. The essence of Kay Fox, as a wife, mother, grandmother, and friend to all of you, was simple and direct—filled with dignity, courage, compassion, loyalty, humor, and love.

"Love. She learned to give her love and receive it back. Nothing made her happier. When my mom got yet more bad news from her doctor, I spoke to her early one morning to see how her spirits were. As usual, she would not give in to the doubt, fear, and anger most of us would have in that situation. She told me why, in a simple sentence: 'I never knew that my children and my grandchildren loved me as much as they did.' That is my mom. A plain pine box and no eulogy."

Kay didn't speak. She just smiled, an endorsement of Robb's remarks.

With great dignity, the pact is honored

Soon after, we celebrated Kay's birthday, grateful for one last opportunity to express our love. But we knew Kay had already endured too much pain and suffering. She was ready to die. Were it not for our faith in God, we might have been sorely tempted to seek some sort of merciful intervention.

Two days later, Kay's heart became weak and rapid, her breathing labored. We sat around her, telling her we loved her. She acknowledged our words with faint movements of her lips as her life and soul drifted away, deserting her body.

Then, like a rainbow after a summer shower, the gurgling in her chest quieted, a tranquil expression captured her face, and her heart stopped.

The pact with God had been honored. "Mir fur dir!"

 

Donald Fox. "Take my life, but spare my son's". Medical Economics 2002;7:111.