“I am too positive to be doubtful, too optimistic to be fearful, and too determined to be defeated.”
This is an anonymous quote from the card given out at Marcel’s funeral. Marcel’s wife sent me this card. It is a beautiful quote. From what I knew of Marcel, he embodied these words.
Let me help you know him a little better . . ..
Marcel was diagnosed with localized colorectal cancer in mid-2011. He had surgery for this cancer. At the time, there was no indication that further treatment was required. His cure rate was upwards of eighty percent and the addition of other treatment modalities like chemotherapy or radiation would not improve his chances.
Marcel started a surveillance program to monitor for cancer recurrence. Unfortunately, only a short time later in the summer of 2012, his CEA blood test began to increase above what would be considered normal. CEA is a protein that can be detected in the blood. In a large percentage of colorectal cancer patients, CEA increases as the cancer becomes more active.
Marcel had further investigations. His cancer was found to be growing in several lymph nodes at the back of his body and in a few spots on his peritoneal surface (the lining of the belly cavity). His case was review with several surgeons in the community; none of them thought his cancerous spots could be completely resected. His cancer was labelled as incurable. He was referred to medical oncology to discuss the merits of palliative chemotherapy with the goals of trying to control his cancer so that he could live longer and feel as good as possible for as long as that might be.
I met a fifty-eight-year-old Marcel in early 2013. He came to see me with his wife. My first impressions of him included the following:
- He was physically large and strong man. I’m not sure how tall he was but his presence took up a lot of space – not in an arrogant or snotty way but in a manner that drew you to him. I could imagine him being in a big room with the circle of excitement around him while he told a good story.
- He was a loud man with a booming voice that could have been owned by a radio or television announcer. His spoke clearly, with a tone of understanding and determination. He already knew his cancer was not curable. He was accepting of this fate. He wanted to know what could be done to prolong his time because he wasn’t done with the land of the living yet.
- His handshake meant business. It was one of those full-on power shakes where both of our hands met fully. Marcel did not dole out one of those floppy haphazard awkward shakes. Perfect pressure was applied and the shake was purposeful. We were immediate partners as soon as that first physical hand contact occurred. He knew it and so did I. I liked and respected that.
Aside from his cancer, Marcel was a well man with no other medical problems. He was on no medications. He had no allergies. He had retired from on oil company management career but still did a fair amount of consulting work, at his leisure, “for fun”, he said. He and his wife spent time south of the border every year. Marcel did not have any symptoms from his colorectal cancer when we met. In fact, I’d be hard pressed to say that he had any symptoms from his cancer at all for the duration of the relationship we shared.
It was expected Marcel would live two to three years. We had two or three different standard lines of chemotherapy that we could try use to control his cancer, trying one until it stopped working as demonstrated by cancer growth on CT, and then switching to the next option, and so on. We decided to start with one of our standard treatment options: FOLFIRI + bevacizumab, a combination of standard chemotherapy with an anti-blood vessel blocking drug. This is typically administered every two weeks.
From January of 2013 until November of 2017 Marcel had sixty-five cycle of FOLFIRI + bevacizumab. That’s right. I wrote sixty-five!! If taken continuously, that would be one hundred and thirty weeks of chemotherapy or two and a half years of the same treatment. If there was a competition Marcel would hold the record for most first-line chemotherapy cycles given to one my patients. This, in and of itself, is remarkable.
More remarkable yet is that his treatment was far from continuous. Marcel took frequent breaks from chemotherapy – to travel with his wife and family, to ride his motorcycle, to go hunting, and even to take a few stints working contract jobs. His breaks from chemotherapy were sometimes only a few weeks and sometimes up to four months. Before each chemotherapy break, he and his wife and I would have a conversation about the pros and cons of treatment breaks as well as the risks associated with the possibility of cancer growth while off treatment. After some of his longer breaks, we would see his cancer progressing on CT imaging. After getting back on his chemotherapy, the areas of growth would always shrink back down.
Most remarkable throughout his entire cancer journey was Marcel’s “I’m not going to let this beat me, no regrets, attitude”. Marcel was a “yes, AND” kind of person, not a “yes, BUT” person. He said yes to chemo AND to contract jobs that interested him, somehow always finding a way to fit them into his schedule. He said yes to chemo AND motorcycle rides which brought him much joy while also allowing him to continue to look biker-cool. He said yes to accepting his cancer AND fighting for more time. There were no “buts” for Marcel, only “ANDs”. Where there were roadblocks, he never once suggested to me there was not a way through it or around it or over it or under it. If there was a way, Marcel found it . . . AND then he found more of whatever there was to be found.
Marcel lived in realistic solutions. There was no denial of what was to come for him. He knew he was going to die, it was only a matter of time. He understood his cancer could not be beaten but he equally knew his approach to this problem was facing it head on, trying to understand it, and building a working relationship with it. It was as if his cancer was his business partner: give a little here, take a little there. In the end, neither he nor the cancer caused much imbalance, and their transactions were accomplished with a very mutual respect. Somewhere along the way, Marcel had given his cancer one of his proper handshakes and agreed to partner with it in a way that allowed Marcel to keep enjoying his life while his cancer ebbed and flowed within him.
In late 2017, I received a phone call from Marcel’s wife a few weeks after what was to be Marcel’s last dose of chemotherapy. She called to tell me Marcel had passed away, unexpectedly. He had recently returned from a hunting trip. Upon his return, his breathing was slightly laboured. Early in the morning he had decided to try to rest in his comfy chair while his wife still slept. When his wife woke up a little later, she found him dead. He likely died of a heart attack or a blood clot, we will never know for sure. He died while his cancer partner was still being controlled with his first line of chemotherapy. His wife believes he died peacefully.
On the back of Marcel’s funeral card there is also a sentence describing Marcel: “Everyone who was fortunate enough to have known Marcel admitted the positive attitude, optimism, and determination with which he confronted all challenges, which no doubt is the reason he outsmarted cancer for so long.”
Marcel died. But it seems to me he died optimistically unafraid and left all those who he loved, and who loved him, without doubt about his positive twist on life. Marcel was a happy man. I know some of that positivity, optimism, and determination rubbed off on me. In turn, it rubs from me to the other people that I love and that love me. That’s the way the world goes around after all. Making a difference to even one person will make the world a better place.
Thank you Marcel for changing our world.
Author notes:
Some people pick a word of the year – to motivate, remind, encourage, set intentions, guide. My word for 2022 is “AND”.
The word “AND” is a connector word that joins two or more things together. “AND” also introduces new material, an addition to something already thought of or in existence.
Over the last year especially, I have decided that I don’t want to leave something undone or unsaid when it really matters to me – in relationships, in helping others, in doing those things that make my insides feel happy. If there is something in my life that makes me feel warm, something that is trying to guide me to joy, I want to follow those feelings.
My word of the year for 2022 is an impetus to make sure I try to do and be the best version of me that I can be, AND then some. I want to go on that hike AND make it to the top of the mountain; I want to work hard professionally for my patients AND play hard at home with my kids; I want to give my special people a hug AND squeeze just a little tighter before letting go. I want to love with every ounce of my heart AND know there is more love to give.
“AND” is how this blog started. I decided to start an Instagram page with abbreviated stories about my patients and how they impact me. Before I even got started with my Instagram page three people suggested I write a blog. My sharing of the things my patients teach me became “The Dignity of Cancer” Instagram page AND this blog. Opportunities in life present themselves when you are looking for them. There is a next level for everything if you search for it.
I recently heard about Bronnie Ware (see bio below*) while listening to a podcast episode of “We Can Do Hard Things with Glennon Doyle”. Ms. Ware is an Australian palliative “carer” (as she describes) turned author who wrote the book entitled, “The Top Five Regrets of the Dying: A Life Transformed by the Dearly Departing”. Her work identifies five of the most common regrets people at the end of life describe. Re-printed here with permission, she writes these regrets the following way:
- I wish I’d had the courage to live a life true to myself, not the life others expected of me.
- I wish I hadn’t worked so hard.
- I wish I’d had the courage to express my feelings.
- I wish I had stayed in touch with my friends.
- I wish that I had let myself be happier.
I see these regrets in my patients daily. I will certainly come back to discuss regrets many times during my telling of patient’s stories because the regrets my patients express about their lives during their cancer journeys are of great interest to me. I believe regrets from those in the process of dying are great lessons from which those still in the process of living can learn from.
I bring up regrets today to highlight the last one Ms. Ware describes: “I wish that I had let myself be happier”. I don’t want to have that regret at the end of my life. “AND” is a way to let myself be happier – to feel joy and love and connection. I would like to believe Marcel used, and lived by, the word “AND”. He gave me the impression he lived a happy life. I hope my impression was his reality.
What do you do each day, reader, to make yourself happy? What is one person, place, or thing, that can bring a smile to your face and that yummy feeling of warmth to your heart no matter the other noise that is happening around you? I am curious to know.
*Bio: Bronnie Ware spent several years caring for dying people in their homes. Her full-length memoir, The Top Five Regrets of the Dying, shares further wisdom from dying people and how Bronnie’s own life was transformed through this learning. http://bronnieware.com/regrets-of-the-dying
