A Reluctant Goodbye

I have two brothers. David is 63 and John is 60.

Thirteen months ago, John was diagnosed with an aggressive metastatic (stage 4b) prostate cancer. Prostate cancer is not genetic, but it can run in families and we have seen it in ours¹. John agreed to his prostate cancer treatment: forty-four radiation treatments for the lesions/tumors. The treatments occurred on consecutive weekdays. It was shitty—at least an hour in each direction to get to get to the medical center—but John not only survived but thrived. He finished in the middle of summer last year; subsequent tests showed that they’d gotten everything, and John was declared cancer-free.

In late February, just before his 60th birthday, John started getting sharp pain in his lower colon and rectum. He had developed radiation proctitis, an exceedingly painful inflammation of tissues that can appear up to a year after radiation treatment. Pain management barely worked, despite the heavy guns of morphine and other opioids. He was often barely conscious and was mostly bedridden. He couldn’t talk on the phone, and he certainly couldn’t text. Warm baths helped, but he had a few ER visits when something was (even more) wrong. He finally started hyperbaric treatments, and they seemed to help him a lot. It was a struggle to get him to eat. He’d quickly lost thirty-plus pounds.

Tina (John’s wife) and sons took care of him. Jack, the oldest, took a leave from work to help his dad. John had a urinary catheter and a bag to catch the urine—the bag had to be monitored and changed. The drugs had to be tracked and administered. Medical visits and hyperbaric treatments had to be coordinated. They went the extra mile to keep John safe, as pain-controlled as could be, and out of the hospital. They were all heroes.

And John was improving. We all had high hopes, especially after a good few days in a row. The family had planned a long group vacation in Sicily in late June, with their doctors’ blessings.

Tina found him on the morning of June 5. He had passed away overnight. A subsequent medical exam/autopsy showed that the radiation proctitis was healing but that the scarring (and the horrible pain) would likely have been permanent. The surprising news was that he was cancer-free; instead, he had succumbed to a heart attack.

It has been a complete shock. No one saw it coming. And we are all heartbroken.

Dad and I traveled to southeast Pennsylvania for the services.

John’s funeral card

There was an open casket visitation. John looked like the old John, before the weight loss. He had no gray hair despite having just turned 60. There must have been two hundred people in attendance—in addition to Tina’s extended family, there were cousins and family friends and high school acquaintances and coworkers. It took over two hours for the line of guests to greet and talk with John’s immediate family. A few people spoke, including his second son, Christian, and including me.

The full funeral mass was held the next day in the parish church where their two older kids had gone to school and the youngest, Luke, is finishing up. About a hundred and thirty people showed up, including first cousins who’d driven all day to attend.

And the end was the hardest: after communion, the casket was closed for the last time. The pallbearers walked the casket solemnly, slowly to the back of the church, followed by John’s wife Tina and his immediate family: Jack and his wife, Nicole; Christian; and Luke. We all walked out behind them and time slowed as we silently watched the casket as it was loaded carefully, slowly, sadly into the back of a black hearse. His destination was the crematorium.

About a hundred and ten people showed up at the luncheon afterward. The mic was open and over the next three hours about thirty-five people spoke about John and what he meant to them. It was charming and funny and sad and sweet. The facility was gorgeous.

The luncheon after John’s funeral

And I am heartbroken. We three brothers kept in touch with one another, mostly via our group text as we dealt with time zone differences. My brothers are confidants and losing John has been profound. I always thought I would go first and it is a shock that he beat me to it. And so I am on autopilot for a lot of things in these gray days. I can’t even imagine what Tina and Jack and Nicole and Christian and Luke are enduring. John was a bright light and I am reluctant to even say “So long.”

1. I scheduled a physical exam with my own doctor, who then referred me to specialists to evaluate my health. My PSA levels (a deprecated diagnostic these days) were normal, as was a physical prostate exam. The cardiologist ordered a bunch of tests, which is how I discovered that I had thyroid cancer. It got treated, and I am now cancer-free.