Sunday, November 29, 2002

Cat's cancer a metaphor for Blakes' own struggle

Marge Sherman Eagle-Tribune Health Writer

When Ric Blake invited a New Hampshire public television crew to film an "end-of-life care'' piece in his Londonderry, N.H., home, little did he know another story of life and death would unfold as the cameras rolled.

With the lens pointed directly at them, Blake and his wife, Diane, learned last week that a small, dark lump in their cat's mouth is melanoma. Even worse, the cancer is growing aggressively and has already spread to her right eye.

Veterinarian Myrna Gregorio, who has cared for the white and tiger-swirled feline called Annie McSmudge for all of her 20 years, delivered the bad news. The Blakes now face the prospect of deciding when it is time to euthanize Annie, a pet who has become a member of the family, almost like a child to them.

The moments after diagnosis in the examination room at Londonderry Animal Clinic took on a surreal quality. Diane cried, though she does not remember the tears. Ric reeled in shock, for an instant sinking into a lonely, solitary place. All the while, a television camera recorded the Blakes' reaction, and a newspaper photographer recorded the television crew doing their job.

Though it was painful, the episode in many ways is emblematic.

For nearly two years now, Blake, 57, has shone the spotlight on terminal illness in The Eagle-Tribune series "Living Well To the End,'' his account of living with a particularly aggressive form of thyroid cancer. He and his wife of 35 years are committed to engendering a public conversation about end of life issues.

Annie's failing health and what to do about it serves as a metaphor for them. Ric Blake sees it as a blessing, a sign that now is the time to euthanize. Diane, 60, is more conflicted. She wanted Annie to live as long as possible, to have a natural death, but the veterinarian's grim prognosis now has her re-evaluating her plan.

When Ric talks about Annie's death, he might as well be speaking about his own.

"Why would you want to keep her alive until it interferes with her ability to eat or drink or breathe? I want the same thing for myself, which is I don't want a moment of pain or terror or even discomfort. There's no point,'' he said. "Diane wants a clear cut incontrovertible truth that it's time. My belief is that in order to get to that point, Annie will have to suffer unnecessarily, and I think that's not a good thing.''

The veterinarian's words last week had a major impact on Diane, putting into perspective all of the symptoms she has been witnessing, but trying very hard to dismiss.

"I'd noticed she is having a harder time walking. She has fallen over in front of me. I'd love for her to live a couple more years, but I know that's not going to happen. She's weighing less than six pounds now. She's getting frail and you can hear her bones cracking sometimes,'' she said. "The writing's on the wall. As much as I'd like to deny it, it's there.''

Though Diane shed tears in the veterinarian's office, it was Ric's turn to break down in the car on the way home, away from the glare of the cameras.

The tears were for the loss of a friend who follows him around the house, cuddles with him, consoles him. The tears were also for the death of the Blakes' other cat Sydney, their "other child'' as they call him. Sydney was a white and tiger mix cat who had a horrible, painful day before he died in the summer of 1999. Blake felt in retrospect that they waited too long to euthanize him. He thinks about it every day.

Diane Blake has other regrets about Syndey. She grieves not having had a proper burial or tribute for him. The Blakes in the panic and pain left Syney's remains at the animal hospital.

"Diane and I both accept that we failed and we failed miserably with Sydney's death,'' said Blake. "Maybe with Annie, we're going to do it better.''

Sometimes in the dark of night, Blake thinks about what will happen when he becomes gravely ill. Will his wife follow his wishes, wishes that he has written out, signed and his wife has agreed to in front of witnesses?

"What if I were lying there and I were sick and I said, 'I don't want to eat any more and I don't want any more water?'' he wondered. "What if Diane said, 'No, you have to have just a little water?'''

Diane is certain that when the time comes, she will do what her husband wants.

"I definitely would follow his wishes,'' she said.

As his cancer slowly metastasizes, growing spots in bones far from the original site in his neck, he thinks about his own death. He does not think of it in a morbid way, but more in terms of making sure he has some control over his own end.

"I have talked to my doctors and I have talked to Diane. I have been very clear with everyone. If I choose to do this, you will respect my wishes. That way I have some say over it, I have some decision-making power, as long as my mind is working,'' he said.

Perhaps Annie McSmudge's impending death is a dress rehearsal for his own, he thinks. The discussions with Diane about the right time for Annie to die could well presage his own death. He hopes his wife will agree to follow his wishes and not cling to hope when he is ready to go.

"I think about it a lot, because in my life, I can't get away from cancer. You think about cancer and you think about metastases, and the next thought leads you to how one dies. And that leads you to decision-making and empowerment and what type of medical team you have,'' he said.

Even though Blake has become, as he sometimes says, a poster boy for the end of life discussion, he is in fact in good shape right now. His face is drawn a bit, probably from the 14 pounds he lost since September, something his doctors attribute to hypoglycemia and monitor closely by checking his blood sugar regularly.

But otherwise, he feels OK. His health is like a gentling rolling wave, good for two weeks, bad for the next two.

When he is feeling chipper, he reminds friends that he predicted in 2000 that he could live another six months or six years. He thinks the same is true today.

Yet Blake is experiencing something that terminally ill people often confront. People avoid visiting or calling, fearing he looks or sounds like he's on death's door. When they do finally force themselves to drop by, they are often shocked at how well he looks.

For all of his hands-on approach to his own health care, Blake's main focus today is on living, not dying. Though he gave up work as information officer at Greater Lawrence Family Health Center a year ago, he is busier today than ever.

He spends hours fashioning jewelry out of Fimo clay and beads. He is penning a gardening book. And he has undertaken a press campaign for a blues and jazz CD his brother-in-law, Jim Zanfagna, is about to release. His days are filled with projects and friends. He is ever the avid photographer and gardener.

"I don't want my death and dying to define my living,'' he said. "Living well to the end means living well. It doesn't mean being obsessed with death and dying.''