Letter from Oregon — From the January 2016 issue

When I Die

An end-of-life doctor faces his own end

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The knowledge hid in the back of Rasmussen’s mind — a flitting worry of the kind you don’t look at directly — for a few days before he really comprehended it.

He was on his way home from a meeting of the continuing-education group he had joined after his retirement. (Though he still practiced medicine at night in his dreams, he loved the chance to learn all the things he’d been too busy for during his medical career: particle physics, economic theory, world history.) One of the group’s members, a woman named Valerie, had asked him to let the others know that she had been diagnosed with a glioblastoma — a type of brain tumor, whose implacable aggression he knew well. A glioblastoma can cause seizures, nausea, memory loss, partial paralysis, even personality changes; one of Rasmussen’s glioblastoma patients confused his family when he lost all interest in bathing. You can treat the tumor with surgery, chemotherapy, and radiation, but it will always come back, often in more places. The timeline can be uncertain, but the prognosis never is. The median period of survival after diagnosis is seven months.

“Always Looking for Light,” by Virginia Woods-Jack

“Always Looking for Light,” by Virginia Woods-Jack

As Rasmussen drove away from the meeting, his left hand was draped on the wheel of his Tesla. It felt, as it had for several days, oddly numb, as if he’d been holding a vibrating object for too long. He’d ignored the feeling, chalking it up to spending too much time power-washing needles and pinecones off his cedar-shake roof.

Maybe it was what happened at the meeting, or the clarity of a wandering mind. All at once he focused on the sensation — on how localized it was, on the fact that it hadn’t gone away — and he knew. Something was wrong. It was wrong in a way whose ramifications he fully understood. “I’ve either got MS,” he thought, “or I’ve got a brain tumor.”

One of the things that he had come to believe about death was that hiding from it was a waste of time. He passed his own first test: his first thought after his realization was to wonder whether it was too late in the day to go to his doctor. Instead of driving home he went straight to an urgent-care clinic, where a doctor sent him to a hospital emergency room, where another doctor gave him an MRI, which showed a tumor. It was, he learned later, a glioblastoma about an inch in diameter. Barring an accident, it would be the thing that killed him, sometime in the suddenly too-near future. He was sixty-eight, and a lament floated through his mind: that he would most likely die before reaching his seventies. Sixtysomething sounded so young for dying. But he considered himself lucky that the tumor was in a part of his brain where it caused early symptoms, and that it was cancer at all — something whose progression he could predict and recognize.

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lives in Seattle. She is a fellow at the Alicia Patterson Foundation.

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