Sunday, December 30, 2001
Getting ready for the end, savoring the now
Marge Sherman
Eagle-Tribune Health Writer
This is the latest in a series of occasional articles on Ric Blake and his
experience living with a terminal illness. Blake, 56, of Londonderry, N.H.,
is a photographer and writer who learned last year that the treatment for
his thyroid cancer no longer works. He agreed to allow the newspaper to
follow him to call attention to end-of-life care. After he recovered from
his initial surgeries for cancer in 1995, he reached out to others and
helped create the support group ThyCa: Thyroid Cancer Survivors Association.
This series is written by Eagle-Tribune health writer Marjory Sherman and
photographed by Cheryl Senter.
Ric Blake is not dying, not now at least, but he is already making his
final plans.
Living with terminal thyroid cancer prompted Blake to make some major life
changes in late summer -- quitting his job as a public information officer
for the clinic Greater Lawrence Family Health Center and giving up his car.
Now he is tending to the details of death and dying.
"Everything I can make arrangements for now, literally, is taking a weight
off my shoulders,'' he said.
He is writing his obituary, arranging to donate his body to medical science,
and acquiescing to his wife Diane's wish to have a tribute to him when he
dies. Originally opposed to any memorial service, he has taken to calling
this a "Celebratory Whatever.''
"People think 'Oh, it's so depressing.' It's just good planning. Because
when the time comes and I get sick, I'm not going to feel like doing any of
these things. I want as little on my plate as possible,'' he said.
Planning for when death comes is no gloomy affair for Blake, though dying
itself far more thorny for him.
"This is a fascinating process. I did not find it morbid at all. And I took
care of getting rid of the stiff... and that took a load off my mind,'' he
said.
Few terminally ill people begin advanced care planning as early as Blake,
who could live another six months or six years. Fewer still inject the
process with such thoughtfulness, laced with eruptions of laugh-out-loud
black humor.
"It is very unique,'' said his wife, Diane. "We do joke. We laugh a lot. The
way Ric treats it, I think he is going to live forever. I stay in a
comfortable state of denial.''
The danger lies in knowing that one day Ric will die.
"He's not fine, really. It's hard,'' she said. "It's too hard to wrap your
mind around that somebody's not going to be there tomorrow.''
Diane Blake hopes she is prepared when the time comes. She relies on her
work as bereavement coordinator for Merrimack Valley Hospice to keep her
anchored.
"It's a really good thing that I work here, because it wakes me up,'' she
said.
What unnerves her the most is when people who were sick for a long time take
a sudden turn for the worse and die unexpectedly.
"It's scary. It shakes me up and it makes me realize that I'm too
comfortable in my denial,'' he said.
Some of her most difficult moments came a few weeks ago when she met for
coffee with a recently widowed colleague she knew from her teaching days at
Springfield College. Smiles and hugs of greeting soon turned into an
emotional and tearful conversation where both shared stories of hope and
loss.
Diane Blake's darkest fear is that the cancer has metastasized and could
take her husband's life all the sooner. She finds herself wondering: Will
this be our last Christmas together? Will we celebrate another New Year?
The Blakes will have a clearer answer when he returns to the National
Institutes of Health in Bethesda, Md., on Jan. 6 for extensive testing to
determine whether the radiation and chemotherapy he underwent last summer
shrank the thyroid cancer tumors growing in his neck.
In the meantime, he prepares for living -- and dying. To try to save what
parts of his voice he can, he asked his internist Dr. Donald McDonah in
Nashua, N.H., to find him a speech therapist. He also asked for an
acupuncturist to help squelch the pain in his hip, but so far, his insurance
company has denied that request.
At the same time, Blake is tending to end-of-life preparations.
When Blake dies, his body will go to the National Institutes of Health,
where he has been a thyroid cancer research patient for 31/2 years. A team
of specialists will study his particular type of thyroid cancer -- called
poorly differentiated follicular, Hurthle Cell.
He fixed on this idea of medical research for two reasons. He wanted to cut
down on the costs of his own funeral and he wanted to enrich the knowledge
of the medical team.
Once the research is complete, his body will be cremated, or "crisped'' as
Blake refers to it, and his ashes returned to New Hampshire to his wife,
Diane.
"She asked me what she should do with the ashes when she gets them back and
I said, let me spell D-U-M-P-S-T-E-R, because that's not me. I know people
are not in the box either. Wherever they've gone, they're not there,'' he
said.
The Blakes struggled over whether there should be a memorial service. She
wanted one. He didn't.
"For years, I've resisted the idea of ... anything that would bring sadness
or cost money. I finally realized that Diane will do what she wants, and I
won't be around to argue my point of view, so I've relented and listed my
preferences,'' he said.
He wants a non-religious celebration where "those who love me should laugh,
dance, tell stories and enjoy the moment."
Religion is missing from the tribute, because Blake is not a churchgoer, nor
is he sure of his feelings about God or afterlife.
"I remain clueless about the universe and the existence of a prime mover
behind the scenes,'' he said.
The celebration will display his passions -- photography, genealogies he has
written, an organization for thyroid cancer survivors he helped create
called ThyCa:Thyroid Cancer Survivors' Association, and The Eagle-Tribune
newspaper series that has followed his journey with terminal illness.
Though he looks far healthier today than he did in September, Blake faces a
daily assortment of pains and indignities. His hip hurts, possibly from bone
lesions. He has developed a tingling down his spine called Lhirmette's
syndrome that could be caused by a tumor on the spinal cord or arthritic
changes from longterm used of the drug synthroid that he has taken since his
thyroid was removed in 1995. Then there is the ever-present cancer
percolating in his neck. Lately, his neck area hurts and he can only wonder
what is happening inside.
Living in limbo, with the cancer time bomb ticking, Blake is critically
aware of each nuance in his body.
He had a short reprieve for three weeks this fall, in the days after he
recovered from the cancer treatment and an accompanying bacterial infection
that drained his strength and lopped off a pound a week.
"For three weeks, I felt as good as any time in my life, except I was
tired,'' he said. "Then the symptoms started coming back.''
Ric Blake's overriding concern, a fear much greater than dying, is when the
cancer will rob him of his voice.
"It's the great dark shadow that rides on one's shoulder. I don't know when
I won't have a voice,'' he said. He thinks about it a lot.
Ric Blake faces the possibility every day that should his tumor grow 1
millimeter into a vital structure in his neck, his voice will be all but
lost to surgery that might be necessary to keep his airway open.
"If I had a tumor in my leg, I would not be so concerned about the immediate
future, but it's not. It's in my neck. It doesn't take much of a stretch of
imagination to think that all of a sudden these things can grow into a
critical structure, and life will go downhill very quickly,'' he said.
As a consequence, he keeps his ducks in order. He is in constant contact
with this doctors, making sure that each one knows that the other is doing.
He makes sure he has pain medication, and he asks for extra types of therapy
that may help.
He has also taken a very social, gregarious turn lately, trying to fit in
every lunch date he can.
"One thing you learn when you have a life-threatening illness is you don't
put things off,'' he said. "I don't put off going out for breakfast and
lunch and meeting friends.''
People tell Ric Blake how remarkable and courageous he is for sharing his
story of living with terminal illness on the front page of the newspaper.
In his typical irreverent fashion, he buys none of it.
"It doesn't seem remarkable to me at all,'' he said, "Because my story
happens to people all over the world, everyday. People make me out to be
something I'm not. I'm not courageous. I'm not particularly smart or wise.''
Yet even Blake knows there is a certain something that readers appreciate in
how he shares his raw reactions in photographs and words in a series.
Perhaps his voice empowers others to ask questions, and if that is so, it
pleases him.
"I do question authority, and I'm fairly assertive. I try to be diplomatic
and a good patient,'' he said. "And, I don't whine and I don't worry and I
don't get depressed.''
For all of his protests, there are some things uniquely Blake. There is his
way of living life in the moment, of appreciating each rollicking
conversation, each change of seasons, and his glory in railing against the
system while working all the while to find an answer.
"You know,'' he said, "I can rage until the end. That wouldn't be unusual
for me.''