“What did he die of?”

It’s a legitimate question. Admit it, you’re curious too. What did John die of? It’s okay. I’d want to know if I were you. It’s usually the first thing people ask. Generally, if people didn’t know his background, I simply say “sepsis after a short procedure” or “pneumonia”. Both of which are true. And honestly I think that’s all people really want to know.

However, it unfortunately tends to opens up in me the need to qualify that simple answer. And for someone to die under the age of 90 from pneumonia, it always makes people want to know more. With his extensive medical history, it seems like his death would have been obvious and not such a surprise, but I just didn’t think he couldn’t also beat this one. It did not occur to me—or to John—until the bitter end, that he had won those earlier battles but we were about to lose the war. I’m fairly certain my audience doesn’t want that much detail. But I’ve caught myself going off far too long answering the question.

What’s difficult about this question is that it’s such a natural question for us to ask one another. Why would any young person die? It’s not in the natural scheme of things. So we want to know. We’re concerned and we’re curious. Totally understandable. We want to know what happened. There’s nothing wrong with that.

About a month or so after John’s death, I was in the bank, transferring some certificates to my name. The bank manager came unglued when he learned that John was my husband. He thought it was my father. To my surprise, he asked question after question, “What happened? Why did he get sick? When did it happen? How old was he?” He seemed genuinely shocked that anyone young could die. I’m not sure which age was his cut-off point for not being horrified. 60? 70? 80? Would it have mattered if it was my father? My brother? I could have thrown him that one as well, but my brother and I did not hold securities jointly. So he didn’t get to be surprised by how young my brother was.

I don’t mind answering the question, even though it’s complex. My brother’s big heart simply gave out one morning, so that was an an easier answer to give when I was asked about his passing. Many young people die of cancer, ALS or other common diseases. Those are also easier to answer.

But I can see that some widows might have a very hard time with the question. What if it was an accident? The natural follow up question to that: What kind of accident? It could be hard to answer, especially for a new widow or if it was a complicated accident. What if it was something even more difficult? Homicide? Suicide? Those then beget even more painful questions and both the widow and questioner get backed into a bad conversation.

I’d think the best way to find out the answer (again, I totally understand wanting to know) is to first say something neutral, like “Oh, I’m so sorry. He was such a young man.” and see what her reaction is. If she’s up to talking about the cause of death, then you’ll probably be able to tell or even just listen. If she’s not, well, either you’re going to remain in the dark or you’ll need to go ask someone else.

Do be gentle with the question, especially at first. Be ready for whatever door you might open up‚ the example being me telling you more than you want to know. Be careful of what you ask for.

And to my fellow widows: know that your friends are not being morbid or trying to make you talk about something you don’t want to. They are genuinely trying to express their concern. If you don’t want to talk about it, make up something neutral and non-committal. Have a convincing easy answer in the bank. “It was a sudden illness.” Then change the subject. “How ’bout them Mariners?” If you’re willing to talk about it, then go right ahead. It’s your call. Do thank them for their concern either way.

Still curious?

Okay, if you’re still curious I’ll give you, Dear Blogreader, the full answer to “What did he die of?” question below. If you don’t want to know, then here’s a link to the New York Times, which is a lot more interesting anyway.

Get comfortable, it’s long.

When you met John, you’d notice he was quite thin. But other than that, even after he needed full crutches and could barely walk, unless you were a medical professional you didn’t really see him as being sick. Or a medical marvel, which he was. He lived his life with a ferocious intensity that overshadowed any physical frailties. He worked a full ten hours the day before he went into the hospital. He was still expecting to get out of the hospital “next week” four days before he died, sending e-mails to colleagues to that effect. He fought until the end and he always wanted to live.

Here’s what was on the death certificate.

Immediate cause:
a) Acute Respiratory Distress Syndrome and Sepsis and Acute Renal Failure
b) Sepsis secondary to Endoscopic Retrograde Cholangiopancreatography (ERCP) procedure

Other significant conditions:
Congestive Heart Failure (CHF) and Pulmonary Fibrosis and Radiation-induced Fibrosis

Manner of death: Natural

I didn’t have an autopsy done. Why bother? As my brother pointed out, he’d bamboozled the medical community since 1970. Why give up his secrets now?

Here’s more. It doesn’t even mention his most debilitating issue, the degenerative disability based in his spinal cord—radiation-induced lumbosacral plexopathy—that was increasingly painful and destroying his ability to walk. He was in a great deal of pain in the last year or so.

He had the CHF because a severe pneumonia six years earlier put too much strain on his already strained lungs. He needed the ERCP procedure because his liver was heading into certain failure since the main duct was blocked. Turned out it had been blocked twenty five years earlier, during emergency surgery to save his life when he was bleeding out due to a ruptured duodenal-aortic fistula. In that surgery, parts of his stomach, lots of his intestine, his duodenum, and assorted endocrine parts were removed. And as it turned out, they sewed up his primary liver duct into the resectioned gut, which is why his liver went into failure years later which required the ERCP to try to open the duct that set off the sepsis that killed him. The 1983 surgery also caused chronic rapid gastric emptying and severe hypoglycemia that caused diabetic-like symptoms.

Oh, and all this started because he had widely-metastasized testicular cancer in 1970. Back when young men did not have much of a chance of survival. He had mixed tumors, including carcinoma, seminoma, choriocarcinoma and embryonal carcinomas. John was lucky enough to be in Houston, where M.D. Anderson doctors undertook a (then) radical approach to treatment involving multiple chemotherapies—including vinblastine, bleomycin, platinum, cisplatin, fluorouracil, and others I can’t recall. Those chemo treatments in varying forms lasted six years. The heavy cobalt radiation treatments lasted a year. The surgeries included unilateral orchiectomy and nephrectomy, RPLND (retroperitoneal lymph node dissection), including removal of many more lymph nodes reaching up into his neck. All that radiation, all those toxic chemicals, all that surgery. They saved his life but they ultimately killed him… thirty-seven years later.

Got all that? Good lord! No wonder he’s dead.

Did you really want to know all that? Probably not. So now you see my dilemma with the question. It either doesn’t say what happened or it’s far Too Much Information. Next time someone asks, I’ll still say, “Pneumonia”. That’s close enough.

[side note: John’s cancer treatments, in much less intense dosages due to the damaging side-effects, eventually became standard protocol for testicular cancer. John’s survival meant they were on the right track to helping others with this cancer to beat it. In 1970, the chance for survival, let alone complete remission, was next to nothing. Now, it’s considered a treatable cancer if caught in the early stages. Hardly short of miraculous.]

Born in 1961. Married in 1990. Widowed in 2007. Blogging in 2009.

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One more thing…

How else do I know what hurts and what helps? Because not only were they done to me… I learned through this process that I am certain to have done the very same "Don't" things to others at some point along the way. If you're one of them, I am genuinely sorry. I'm trying to learn.