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12/7/97
A thief in the night
Cancer's a thief.
It robs it victims of energy.
It steals the nourishment they get from their food.
And it ruins their bones and their organs.
They lose weight and they lose stamina. Their bones become brittle, too, and a simple stumble on the stairs could be fatal.
People with advanced cancer sleep a lot and often feel tired, even when they just wake up.
Cancer takes everything it can, sometimes it even takes a person's desire to live.
In Chuck Snook's case, cancer has done a lot of those things, but it hasn't robbed him of his will to live and he still has his sense of humor.
"You should see me naked," he laughs on a good day. "I look like a bird."
Well, he's 6 feet tall and weighs 183 pounds, down from the 285 he weighed on Nov. 10, 1994, when a physician told him he had prostate cancer, that it had spread to his bones and there was nothing he or anybody else could do to stop it from spreading further.
Chuck's constant companions now are the cane he uses to help him walk, a rather knowing smile from the side of his mouth and pills, piles of pills.
And something new entered his life on Wednesday: It's called hospice care.
Several months ago Chuck called OSF Saint James Hospital in Pontiac and made the arrangements. Now he was getting on with it, and with something else, too.
Hospice care is designed to help people with terminal illnesses, and their families, through the final six months of their lives.
In November Chuck visited with Dr. Robert Dreicer, a physician in charge of a pain management study last year at the University of Iowa Hospitals and Clinics in Iowa City. Chuck, and Iowa native and doctoral graduate of the university, has returned to Dreicer for occasional monitoring since the study ended. He went there last month because of increasing pain in his arms and legs, particularly his arms.
He got good news and he got bad news, and he got some advice. The good news: X-rays showed now break. The bad news: X-ray showed the cancer was even more widespread. The advice: Get hospice care now.
Betty Rainey, Chuck's case manager, was in his living room Wednesday, full of questions and answers, and especially reassurance for Chuck, as well as his wife, Eve.
For every hour of every day for the remainder of his life, she told Chuck, he will have the services of a nurse, an aide, a social worker and a chaplain. Every hour of every day. Pick up the telephone and call. Somebody will answer. If he can't call, he'll have a pager. And he'll have a monitor, too, from his den downstairs, where he now sleeps, to Eve's room upstairs.
"I want you to enjoy every day that you have," Betty told him.
That appealed to him. "We'll have a ball in the next few weeks," he said.
So, on to the basics. Height: 6 feet. Weight: 183 pounds. Heart rate: 100 and slightly irregular. Blood pressure, 128 over 64.
Major medical procedures: A benign tumor removed from chest, 1956; eye surgery, 1962; 15 radiation treatments, March 1997.
Other physical conditions: Moderately high blood pressure, slightly swollen feet.
Appetite: A bowl of cereal for breakfast, soup for lunch and small portions of whatever's put before him for supper. "We just had an old-fashioned Thanksgiving dinner," he said, and he even ate some of it. But it was the first time in 18 years that Chuck didn't cook it himself.
Eve and his daughters took over the kitchen that day. Then, the next day they went shopping while the other men and boys went swimming and Chuck watched some football games "from a prone position."
Nearby, on the small table in his den, are his books and his medications:
Every day he takes 14 40-milligram tablets of the timed-released pain reliever Oxycontin, four 400-milligram pills of the anti-inflammatory ibuprofen, two tablets of the stool softener Senekot S, eight 5-milligram tablets of hydrocortisone and one 10-milligram tablet of the blood pressure medication Norvasc. In between his two daily doses of Oxycontin, he may take up to five 5-mg. tablets of Oxycodone, a faster-acting "break-through" pain reliever as often as he needs it. Without the Oxycodone, he takes 29 pills a day.
From the beginning of what Chuck calls his adventure with cancer he has said his motto is "Better living through chemistry."
What Betty wants to know now, though, is how much pain he is in at the moment, and a straight answer is not forthcoming. She persists. On a scale of zero to 10, she asks, with zero being no pain and 10 being agony, where would he put himself?
Chuck gently rubs his arms. He rocks a little in his seat on a living room couch, and he can't come up with an answer. He just can't pin it down at first, but he gets around to admitting to a moderate amount of pain in his legs and arms.
It turns out he is running low on Oxycontin, so he hasn't been taking all seven tablets he's supposed to twice a day. He's trying to stretch out what he has left until his new supply arrives.
So Betty reassures him that under hospice care, he will always have as much medication as he needs. If he can't get it at his local pharmacy when he needs it, or he runs out unexpectedly, she'll get it for him from the hospital pharmacy and she'll bring it to him personally if she has to.
Just call: That's what she's there for.
"If zero is no pain," she says, "I want you at a two or below."
She also wants him to begin keeping track of how he is taking the break-through Oxycodone pain medication. If he has to take it more than three times a day, she says, it's an indication that his dosage of Oxycontin isn't strong enough and an adjustment may be necessary.
Later, Chuck says the anxiety he had about his low supply of Oxycontin has given him a little insight into what a drug addict must feel as his fix wears off. It isn't a pleasant feeling.
Others may call what Chuck is living through an ordeal, but from the time he learned his case was terminal, he has kept a remarkably upbeat attitude, always learning something about the human condition, always finding irony or humor in the situations he faces.
He also has taken care of things as they arise, planned for the future and never dwelled on the negative. And he's been pretty successful at it. His funeral and cremation have been set, and Eve knows his financial benefits have been arranged.
Chuck kept his job as principal of Flanagan High School as long as he believed he could be effective, retiring at the end of the 1996-97 term. He and Eve continued their custom of taking short vacations with friends even up through last summer. He still enjoys an occasional dinner out, and he's usually able to find something to laugh about.
But there was a real touch of anxiety in his voice when he discussed his supply of Oxycontin. I look at those pain pills as (if) they're my lifeline," he said. And well they may be.
"Death," he says, "does not bother me. ...It might be the greatest of all adventures that I'm going to have."
But the pain that accompanies his cancer, and intensifies as the disease grows, is something he knows can rob him of what little he has that still gives him pleasure.
"I don't sit here in a void by any stretch of the imagination," he said. He has his book: There is always the one is reading--history, current nonfiction, novels, poetry, even a potboiler now and then. And there are several waiting. He enjoys watching "Oprah" on television, too.
Sometimes he goes into town for coffee. He even started to grow a beard before Thanksgiving. It reminded him, he said, of the summer trips he made to the north woods of Minnesota with his friend and fellow teacher Ray Zimmerman. It was a time when he was young and strong, and death was a long way away, and something that happened to other people. But Eve, he said, thought the beard made him look old, a though in which he finds a lot of humor.
Chuck Snook is 59 years old. If he lives that long, he'll celebrate his 60th birthday on Jan. 31. Getting old, or even looking old, is not something that concerns him.
Getting quality sleep, reading his books, keeping up with friends, keeping down the pain--those are his concerns as he lives out his days. And it's no matter of comfort, pure physical comfort, for without it, there is no peace in his mind.
So, because there is peace of mind, and more, in a good marital relationship, he shaved the beard.
But he keeps the memories.
And more:
He and a friend who died last year used to talk about death, he said, and each asked the other if, after he died and found out if there was a heaven, if you'd come back and tell: "And I said no," Chuck remembers, " would never tell, because hope and wonderment sustain us, and there's always wonderment about death.
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