My hearts knows "to every thing there is a season, and a time to every purpose under the heaven." My logical mind, though, is less accepting. I wish my brother John's season had been longer.
John was 21 when he breathed his last breath in 1976. This month, although I was there when he died, I ordered a copy of his death certificate to see if it held any secrets. The official cause of death was, of course, no surprise: "Disseminated Hodgkin's Disease."
"Disseminated Hodgkin's Disease" describes what is now called end-stage Hodgkin's Lymphoma. The Mayo Clinic says that the cause is uncertain, although this cancer of the lymph system begins with a genetic mutation in a lymphocyte. Further, "The mutation tells the cell to multiply rapidly, causing many diseased cells that continue multiplying." Risk factors include a young age, family history, being born male and a past Epstein-Barr (mononucleosis) infection. Although I have entertained theories, my brother's early disease remains mysterious.
John joined the US Navy when he graduated from high school, becoming symptomatic with advanced disease after about a year away from home. The Navy cared for him at his post, but later transferred his care closer to home so he could live with his family during his last months. His medical treatment and his own will to live gave him a few more months than expected.
Before he came home, though, his entire family, all five of us, drove straight from South Carolina to Virginia to be with him when he came out of a surgery to remove his spleen in a procedure known to help certain patients through chemotherapy. It was one of the few family trips we ever took.
I wish I knew then what I know now about cancer. When John called home at 19 to tell us he was sick, I did go to my university's library to check out a book. I was 18. I was an English major. What sense could I make of the facts on John's disease in the medical textbook? I tried. It made me feel better to think that I could begin to understand what was going on in my big brother's body. This curiosity about the scientific details of cancer has never stopped.
Although John's prognosis was never good, he did undergo myelosuppressive chemotherapy and radiation. He also enrolled in college classes. His hair fell out and his head swelled with lymph fluid, disfiguring him at one point in his last days. He still went to class and hung out with his friends. He often sat on the couch and talked to our mother for hours about the meaning of life.
John felt horrible his last months. Nausea medicines were not very helpful. Pain medication was rationed. Sometimes he retreated upstairs to the bedroom he shared with his two brothers, sometimes alone with Beethoven's Ninth Symphony turned as loud as it could go. His beloved music, from the Beatles to Beethoven, was one way he dealt with the pain, upstairs or down or in a car.
Perseverance in the face of great pain and nausea and impending death is a lesson John gave me. Seeing him so sick, though, I vowed I would never manage cancer treatment. Later I found that I could, especially in a century with better anti-nausea meds and a house with more than one bathroom. Just as I am fortunate that my invasive cancer was detected earlier, I will always wonder why his cancer was not. I will always wonder why his life was, truly, like a candle in the wind.
Recently, on Facebook, I asked a group devoted to nostalgia for our hometown of Columbia, SC, if anybody remembered John Mitchell, Dreher High School class of 1973. One woman said that he had sometimes walked her home on his way home to our house. They had philosophical conversations. Somebody else mentioned how smart he was. Another asked what kind of music he liked when I said that listening to music he loved helped me to stay in touch.
When John came out of surgery for the splenectomy, each us went in to visit, one by one. When I got to his bedside, he reached out his hand and held on tight to my hand. Thinking about that now, I remember how he was still in diapers himself, 14 months older than I, he was the one who often fed me my bottle. He was the big brother who held my hand.