Sunday, June 15, 2003

Cancer patient trades tenuous hope for a solid here and now

Marge Sherman Eagle-Tribune Health Writer

On a sunny afternoon in Ric Blake's spring garden, a heady scent of lily of the valley filled the air, wind chimes tinkled in the breeze and the sound of new age music wafted from a portable CD player.

Under the arching lilacs, Blake and his wife, Diane, and a handful of invited friends gathered to celebrate the life of their cat Annie McSmudge and to bury her ashes in the garden. The Blakes decided to euthanize their cat in December after an agonizing debate about quality of life and the proper time to die.

For Ric Blake, whose journey with aggressive, terminal thyroid cancer has been followed by readers of The Eagle-Tribune, the death of his 20-year-old cat hobbled by cancer was a metaphor for his own struggle. He wanted for Annie what he wants for himself -- to live life in the moment and to die on a good day, a day without pain or remorse.

Blake agreed to share his story because he wanted to promote the cause of care and comfort at the end of life. Once the window into his life was thrown open to newspaper readers 21/2 years ago, it has remained so unflinchingly -- through chemotherapy and nausea, informal parties at home, walks in his garden, a phase of painting practically everything in his house purple and visits to the doctor.

Now, six months after euthanizing his short-hair domestic cat, Blake stood amid the hues of green, burying her ashes. The irony was that Blake, the patient who did not know at the outset whether he would live another six months or six years, had survived to see another season in his lush garden but his pet had not.

Not that Blake even wanted this party for his deceased cat.

"If I had my druthers, we would have done nothing for Annie -- no statue, no stone, no party," he said. "However, Diane did want to put Annie's ashes into the garden and have friends over for a celebratory party and I supported her wishes."

He softly patted his wife's head as she choked up -- just once -- while reading a passage penned by death and dying expert Elisabeth Kubler-Ross.

"Vaya con dios," she concluded.

Blake gently placed the folded square holding Annie's ashes into a hole he had dug nestled in a stretch of hosta, under the shade of purple and white lilac bushes. He filled the depression with stones and dirt, then gently placed on it a cement replica of Annie, painted with her exact markings -- a smudge on the nose and dark spots on the paws.

"This was her favorite place in the garden," said Blake. "She spent a lot of time here."

Blake has been spending his own share of time in the garden these days. He no longer thinks in terms of seasons because he doesn't want to disappoint himself. Instead, he enjoys each day as it comes along -- pulling weeds by the St. Francis of Assisi statue, or "Frank" as he calls him, sitting on the deck overlooking a garden filled with splashes of kitsch and whimsy, chimes, a purple gazing ball, various wire figures, bird feeders.

Last autumn, Blake wondered whether he would survive to see this spring. When the first days of March came along, he wished the snow away so he could get outside and start digging.

Blake still looks deceptively well -- his color is robust, beard and hair have grown back since chemotherapy -- but inside he feels increasingly tired and in pain.

Since he wrapped up two years of care at the National Institutes of Health in Bethesda, Md., last November, he has undergone external beam radiation in Nashua, N.H., for bone metastases in his right leg, continues to take a monthly infusion of Zometa to help tamp down the bone pain and returned to the care of Massachusetts General Hospital endocrinologist Gilbert H. Daniels.

For one month after he underwent radiation on the cancer in his leg bone in January, he was pain-free. It felt like a miracle. Then, slowly, the pain returned, dashing his hopes that the radiation would keep the cancer in his leg at bay for a year.

"It was very disappointing," he said. "It was bitterly disappointing. I knew it may not destroy the tumors but I thought, 'Well I may have a year.' ...

So, now they're back; the pain's back. I hate it."

When he returned to Massachusetts General to see Daniels for the first time in 26 months, the doctor encouraged him to be vigorous and aggressive in keeping his options open for treatment.

Blake, however, is feeling less inclined to run to try the next big thing.

"I guess I don't really have a lot of faith they're going to come up with any kind of magic." he said.

If Blake were interested, he could follow Dr. Kenneth Ain at University of Kentucky, who tests thalidomide as a treatment for patients with anaplastic thyroid cancer, the most aggressive kind. Or, he could follow his former doctor, Nicholas Sarlis, who left the National Institutes of Health last year to head to MD Anderson Cancer Center in Houston to continue his research using a combination of radiation and chemotherapy to treat thyroid cancer.

Blake has no intention of chasing cures around the country, especially considering that all of Ain's patients to date have either died or shown no progress.

"I'm not going to Texas, I'm not going to Kentucky, and I'm not going to Bethesda chasing hope. That's not what my life is about. That's not what my philosophy is about. I told Gil (Daniels) about this and he said, 'Well, you're the captain of the ship. We can do whatever you want, however ... ' "

That equivocation translated into a sort of compromise. Blake agreed to undergo a series of five computerized tomography, also known as CT, scans in early spring at Massachusetts General so that Daniels will have a baseline of views of his head, neck, abdomen, femur and tibia, just in case a feasible treatment should come along. The tests show no surprises, Daniels wrote this week. The cancer is still there.

The new radiation scans confirm that Blake has been on a pretty good treatment plan for nearly eight years. The combination of radiation and chemotherapy prescribed at NIH for cancer in his neck nearly two years ago probably saved his life. It reduced the cancer in his neck by half and stopped or slowed the growth. The radiation this winter to cancerous spots in his leg bones slowed or stopped the growth there. All of which makes Blake say that his cancer is being managed the best it can be.

"Everything is kind of quiet. If it's growing, it's growing slowly," he said. What Blake wishes for now, after two years of aggressive treatment, is a nice quiet period, a time when he can invite friends over for lunch or picnics by the garden, a time when he can repaint his windows and some furniture.

"You know, I've been really aggressive for the last six years or so, and right now, I'm following my treatment plan, doing what I'm supposed to be doing: living well. That's the point. I'm living well. I'm more focused on quality of life and really enjoying myself," he said. Still, Daniels will now serve as his medical guide, offering hope and inspiration for another chance down the road. "He doesn't want me to quit being aggressive with this disease," said Blake. And, will Blake say yes? It depends, mostly on the toxicity of the drug or therapy. "I see too many people who do treatment that produces no results, and the quality of their life really suffers," he said. "And I don't want to do that. Now, if they come up with a treatment that does not have horrific side effects, or if they had any positive results, I'd say 'OK, I'll consider that."'