3/2/97

Another day worth living

It's hard to say when a man becomes consumed with the imminence of his death.

Perhaps it begins at the very moment he learns he has a terminal illness.

Maybe he cries, trembles, shakes with fear. Maybe he begins immediately to strike bargains with whatever he considers a power higher than mere medical science. Maybe he just denies the diagnosis.

"Uh, uh," he says. "Not me. Can't be me. The doc's got the wrong guy."

Early on the afternoon of Nov. 10, 1994, Chuck and Eva Snook of Flanagan sat in the Bloomington office of Dr. Thomas Kulb, who told Chuck: "You have bone cancer of the spine and rib cage."

Further, he said, it could not be cured, only slowed.

Chuck, it seems, did not react in any typical fashion.

"At last," he wrote in the journal he soon began keeping, "I had my answer." The cancer in his bones had begun as cancer of his prostate, which he had never had examined, until he noticed, as he wrote, "I was urinating up to 12 times a night," and a friend urged him to see a doctor.

Now, though, it was too late.

Nov. 10, 1994. He was 56 years old.

Well, Chuck Snook is a man who doesn't look back. He was happily married to his college sweetheart. They had three children and three grandchildren. He had a job he loved, principal of Flanagan High School. He liked to cook. He and Eva liked to spend their summer vacations in the northwoods of Wisconsin. A former English teacher, he loved to read. He played drums in a jazz combo whenever he got the chance, which wasn't often enough any more. And down there in the basement of that farm home they rented south and east of town, he was a basket weaver.

Now had had cancer and it was just a matter of time. Well, what part of one's life span isn't? he reasoned. Lightning could strike. He could get hit by a truck. He could die of a heart attack right now. All that sort of thing went through his mind. It still does.

Besides, ever since he barely survived an infant illness in the maternity ward where he was born in 1938, he figured he had been living on borrowed time.

All things being equal, if left untreated, his cancer would pay off that loan in two years. Go with one of two treatments, he might take another 18 months of payments. Things were already looking better.

Find the humor in this, Chuck thought. That would become his motto, that and better living through chemistry because pain medication would become very important to preserving the quality of his life.

His treatment option were monthly medication, at a cost of around $500 each, which would destroy his body's ability to make testosterone, the hormone that was feeding his cancer; or have his testicles, which produce testosterone, removed. He didn't even leave the doctor's office before making an appointment for the second option.

Then it would be three months before he found out if it worked.

He and Evan spent that Christmas, the first after his diagnosis, at the home of their daughter and son-in-law, Jeanne and Brett Anderson, in Dubuque, Iowa. Their other daughter and son-in-law, Annemarie and Brad Allen were there from Houston (they now live in Coralville, Iowa) and their son and daughter-in-law, Sean and Lori Snook came up from Macomb. Of course the grandsons, Casey and Reily Anderson and Charlie Allen, were there, too.

Back in Flanagan, Chuck learned that a friend had terminal brain cancer, and they talked on Dec. 30, 1994. "It was good to share our feelings and thoughts. Sometimes," he wrote in his journal, "you just can't do that with a person who hasn't walked in your shoes."

Chuck and Eva spent that New Year's Even with longtime friends in Cordova, a small town near the Quad Cities where they had lived, and worked and even bought a house from the widow of a friend who had died from cancer.

"It was good to be with people you enjoyed and had known for a long time," he wrote. Then he added:

"The old year had ended with me having acquired a shadow that would follow me into the new year and beyond."

One way to detect and keep track of prostate cancer is through a blood analysis called prostate-specific antigen (PSA) test. A normal reading is 0 to 4. Chuck's first reading was 200. His second was 291. Three months after the operation, it was 2.9. Apparently the treatment was working, but already he was recording in his journal an awareness of increasing pain.

His physician in Bloomington told him it may even drop to zero, but eventually it would begin to elevate again and there would be nothing then to stop it.

On Feb. 20, 1995, he wrote that his life since diagnosis "was pretty much a normal situation. Oh yes, I had the occasional pains in my back and rib cage, but on the whole I was feeling good. Most of my friends kept telling me that they couldn't believe how I was dealing with my cancer. 'What other choice did I have?' I would tell them."

His friend with brain cancer died five days later; he heard about it and decided to look into a pain control study at the University of Iowa Hospitals and Clinics for people with prostate cancer; he and Eva went to the high school prom, but he had to leave early because of the pain in his back and ribs; and that summer he and Eva took vacation trips with friends to northern Wisconsin and northern Michigan.

On Jan. 1, 1996, he wrote that his "health is changing somewhat. The soreness comes more often and stays longer." A month and a half later he learned that his PSA was on the rise: up to 59. "The upward movement of the PSA count is irreversible. I will be given medicine to control the hormone (testosterone) production of the adrenal glands. This medicine may buy me some more time."

And then: "Time and conditions change the way one approaches situations. For months now I have tried to prepare myself for the day that the count would start to rise. I just hope that I have done a good job in my preparations. The element of time is very important to e as I prepare for my fate. Family and friends have always been important to me and now those family members and friends will play a most important role in the months remaining. They will become my greatest support system."

Considering the alternative, 1996 was a pretty good year for Chuck Snook.

He was getting used to the idea of living with pain and medication. In March he wrote that he "had come to grips with the pain and the taking of pain pills. At times, without the use of the pills, I can't function. By taking the pills, at least I can go through a day in normal fashion."

In April he learned that the drug he was taking to lower the testosterone production of the adrenal glands didn't work. His PSA was up to 168 and his physician wanted to discuss chemotherapy. But he had heard stories about how that particular form of therapy is as bad as the disease it tries to fight.

"Some wise man once said, 'That time and thought may result in change.'" he wrote on April 12. "That change came today while I was sitting at my desk at school. For 1 year I had conditioned myself to the reality of my situation. I knew that it had advanced to the stage where recovery was not an option. So, I said to myself, 'Let's make the best of it.' My life has gone on in a normal fashion. My psychic was positive and I enjoyed my work."

There would be no chemotherapy for Chuck Snook.

But there would be Dr. Robert Dreicer and the University of Iowa Hospitals and Clinics, there would be increased dosages of Oxycontin and Oxycodone for pain, and then there would be that research project to study the effects of a drug called Suramin on pain control for people with advanced bone cancer.

The Suramin study would be short and intense. He would get the drug or a placebo, and he wouldn't know which. For the first week, in June, he went to UIHC once a day for the treatment. Beginning June 25 he started nine weeks of one-a-week treatments. He also learned that his PSA was up to 450.

"But," he wrote, "I still feel great."

That summer he answered a quality of life questionnaire each time he went to UIHC for the Suramin study. He was glad to do so. He was happy. He and Eva camped with friends in Iowa and Minnesota, and they celebrated their 35th wedding anniversary on Aug. 12.

Chuck's PSA dropped from 450 to 224 in July, but was up to 340 in early August, down to 178 a week or so later, and up to 358 near the end of the month.

There were also reality checks, as he called them: One of his teachers was killed in an automobile accident in June, one of his best friends died in August, a week later another friend died and yet another friend died in September. All were unexpected.

"One would like to ask why," he wrote. "Life, however, isn't committed to answering that question."

Chuck, though, was committed to continuing to live the best life he could. He went to work. He went to football and basketball games. He and Eva visited friends and friends visited them. Chuck continued to take pain medication. He continued regular visits to UIHC to keep track of his disease. His PSA continued to fluctuate, too.

In November, as he marked the second anniversary of his diagnosis, noted his life expectancy. "If we can believe statistics (and sometimes they can be off a month or two) I have between six and eight months left," he wrote.

That meant his next birthday would be his last and that he was probably in his last school year. But he wasn't done yet. He was not about to sit and wait for it to happen.

He and Eva went to a football game in Urbana "to watch our beloved Iowa Hawkeyes beat Illinois." They went to LaSalle for dinner with friends from Chuck's earlier days of teaching at Prophetstown. They learned that Chuck's PSA was up to 854 (he jokes that he's aiming for 2,000). And during a cancer awareness program at Flanagan High School, Chuck spoke to the boys about prostate cancer.

A visit to UIHC in December confirmed what he already knew, that his cancer continued to grow. His PSA was 1,265.

In February, Gail Reynolds, the UIHC nurse in charge of his case, cried when she saw he was losing weight. Chuck put his arm around her, patted her shoulder and said, "It's OK. Everything's OK." It wasn't for her, of course, but Chuck was trying to tell her that he was accepting what was happening to him.

Neither the doctor nor the nurse like what they saw in Chuck's bone scan, so the doctor ordered X-rays. He ordered stronger doses of pain medication, too, and he ordered radiation therapy. That would slow the effects of the cancer in Chuck's legs and pelvis, and reduce his chances of a break that would not heal.

Chuck had his first radiation treatment Thursday at OSF St. Joseph Medical Center in Bloomington. Tomorrow he will have his third, and then we will have a dozen more.

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