An Old Friend Calls in a Promise
by Bayla Kraft

You know those rare friendships that thrive even when you’ve been out of touch for months—even years? That’s how my friendship with Karen was and why, when she called with grim news, I went right to her apartment, though we hadn’t spoken in a year. We had become friends in our twenties, when we were both working for an Arlington radio station—jobs far removed from our eventual careers. Karen had sold radio time, I had done voiceovers and handled commercial traffic, and after work we regularly met downstairs for drinks in a restaurant called the Pawnshop. The friendship had a solid base in rebelliousness, vulnerability, and dark humor. We had both grown up locally, I in the District, Karen in Arlington. We had both left home as teenagers. We both had conflicted relationships with our families. One night, over several glasses of wine, after talking about our disease phobias—especially our fear of cancer—we made a pact. We promised to be there for each other if tragedy ever struck.

Then our lives took different directions. She went to Germany and to India for a while, and traveled the world. She worked for a record company and then developed a successful business as a headhunter. She lived alone with her cats and had a lot of friends. I returned to grad school, started a psychotherapy practice, got married, and had two sons. But we stayed in touch.

And now, 27 years after our radio days, on a cold day in December, Karen was telling me she had metastatic colon cancer. A healthy, active woman, she had gone for a physical in early November 2000 because she didn’t feel well—she just felt something was wrong. A blood workup later that month showed her liver enzymes to be off, so the doctor ordered a CAT scan, which revealed masses in her liver. At 46, she was too young for a routine colonoscopy, but the one she went for in late November revealed a tumor embedded on the side of her colon, which is why she had experienced no bleeding or discomfort. The colon cancer had already spread to her liver.

“Will you be there for me?” she asked. I would, indeed.

Karen was not in a relationship with a man when she was ill. She was never married and wanted to be; I think that was one of her deep regrets. But over the months I accompanied her through treatments and doctor visits, joyful outings and gut-wrenching conversations, I learned that Karen’s being single and childless did not, in the end, matter nearly as much as having good friends to make the journey with her.

***
I couldn’t have helped Karen through the next ten months had I not had had my own encounter with cancer. Three years earlier, when I was 47, I had returned from a vacation to learn, from a routine mammogram, of possible trouble. Two days later a biopsy confirmed stage-one breast cancer and the surgeon performed a lumpectomy, followed by six and a half weeks of radiation and five years of oral Tamoxifen, the drug of choice for a hormone-receptive tumor – and a great relief, because I feared chemotherapy.

I learned that once you have cancer, the world becomes cancer—there is nothing else. My radiation oncologist told me, “The hardest part is going to be getting on with your life, because cancer changes you forever.” You wait until it comes back or it doesn’t. You never lose that fear but you also become grateful for the things you have. You really learn what it means to take one day at a time.

My vision of myself had always been that if cancer struck I would totally fall apart, but once I actually got it, I felt surprisingly grounded. Exposed to cancer patients – people I sat with daily during radiation, whose cancer had often been detected at a later stage than mine – I saw the fear in their eyes, but also the courage and determination. I became less afraid, less phobic, less fragile. The fear didn’t go away but, after a lifetime of cancer phobia, I became a trouper. My bout with cancer prepared me to help Karen with hers.

Still, although my level of neurosis had dramatically lessened, we both knew that the only way I could help her was to have a CAT scan to confirm that nothing was going on there right now. After a lifetime of health phobias, I needed it so I could put aside concern about myself and focus on her.

***

Karen had surgery at Johns Hopkins in January. Afterward she radically reduced her headhunting business. The prognosis was not good, but Karen was taking things one day at a time. It was interesting to see how Karen’s friends reacted toward her illness and dying. Jean, her closest friend, worked full-time but was there every day after work; other friends came often; some friends came to see her just around the dying time; some suddenly stopped coming. Karen figured they were having a hard time dealing with what was happening. I had cut back on my therapy practice during my treatment for breast cancer and had more time to spend with her than I normally would.

People sometimes avoid going to see friends who are dying because they don’t know what to do or say. But some of my most powerful memories of these months with Karen were of just lying on the bed with her, holding her hand, watching television together, and saying, “This sucks.”

Karen was a people magnet. A lot of people liked her and she liked a lot of people but as she grew sicker and weaker and more involved in chemo, she backed away, wanting only a few people around her – those with whom she could feel or say anything. At times she would snap at us, then call later and apologize. We reassured her that she was entitled to be short-tempered. She knew that nothing was off limits. She could say horrible things about her mother, her sister, other people, the world—and it was all okay. It helped her to be able complain about ways people tried to help her that weren’t helpful. She was dealing with a lot of conflicting feelings.

People called from all over the world. Any given week she might get seventy messages and she checked her voicemail regularly. She became more open about her feelings and her thoughts, going from periods of weeping to periods of laughing to periods of saying, “Why are they calling to see how I am? What do you mean, ‘How am I?’ I’m dying – okay?”

***

Because she was too ill to run her business, she couldn’t afford her apartment anymore. Many of us offered to contribute to the rent but she felt that she was going to need help and didn’t want to be alone. And the truth was, she needed somebody to be there every day.

For a while she talked about moving to her mother’s house and putting her furniture in storage—so that if her health turned around she could get her own place again. Briefly, that made her happy, but a couple days later she said, “Who am I kidding? I’m not going to make it. I’m going to sell it all, and if something happens and I do make it, I’ll go out and buy new things.” Karen and her mother were both independent and strong-willed and Karen knew it wouldn’t work if her mother’s house was suddenly invaded by Karen’s beautiful furniture, so Karen put an ad in the paper and held a sale in her apartment, keeping only enough to furnish her room in her mother’s house.

Having hordes of people ask “How much is this?” about the things she loved was brutal. People wanted to know why she was selling everything and she wondered what to say. “Moving sale?” I suggested.

“Movin’ on up,” she said, and began singing the Jeffersons’ old song, “Movin’ on up to the East Side.”

***

Karen’s mother gave up her bedroom for Karen. We had it painted and arranged the familiar things she loved: her Buddha, a lovely chair, some spiritual bells she had bought in India. Many friends got together, packed her apartment up, and moved her to her mother’s house in late May.

Karen’s mother is at once strong and feisty, warm and cold, and they had not always been close. But her mother took her in when she was dying – which, believe me, not all mothers can do – took care of her the best she could and when she couldn’t would tell Karen to call one of us. It wasn’t easy for either of them because they were both used to being alone, but the arrangement gave Karen an opportunity to resolve old issues with her mother – normal adolescent stuff that they still fought about: that the mother was closer to Karen’s sister; that Karen, as the strong, successful one in the family, always had to fix everything; that Karen was there to help take care of her father when he died and her sister wasn’t. (Karen could always step up to the plate.)

Karen and I took her mother out to lunch for her eightieth birthday. “You’re a really good mom,” I said, and she said, “Well, it’s taken me a long time to learn.”

***

At Starbucks one day she admired a stuffed animal, a leftover Christmas bear, with wings, so I bought it. Louise, the chemo bear, came with us most days to the doctor’s office, bringing Karen comfort during chemo. On the way we often stopped at Wendy’s to buy a Frosty – the only thing the health-conscious Karen (who normally exercised four times a week) found palatable some days. Early in chemo she would drink the whole thing; toward the end she might manage one swallow.

Her whole chemo experience was horrid – they could never manage the nausea – but she never lost her sense of humor. After chemo or a doctor’s appointment we often went to get prescriptions filled. She was so weak one day that she asked me to get one of the Giant pharmacy’s mobile scooters and come back for her. I was doubtful but she insisted; she was too weak to walk. The manager helped me get it started, and BAAM! I drove right into the cereal display. I sat amidst scattered cereal boxes watching Karen, at the end of aisle 11, laughing. It felt good to see her laughing. When the boxes were cleared, I drove down the aisle and she got on the scooter, saying, “I’ll take over from here.”

Always there was the chemo and, for months, the hope that it would lick the cancer. One day Washington Radiology told her that one of the fifteen tumors in her liver had shrunk a little – not that these fourteen other tumors were going to kill her, but that one tumor had shrunk a little. You could see the joy on her face: Something is working here, and something working can mean it’s going to work more.

On some level she held out tremendous hope, and the hope never went away, and when she wasn’t hopeful, she was honest about her fear. But quietly the degree of hope changed and she became realistic. She was dying.

***

Being a nurturer was one way Karen had stayed in control of her life. Every day she asked how I was, how I slept, if I was scared, if this was going to be okay. I told her that for once in her life she had to learn to be taken care of. Now she learned to let love in. It was amazing to watch. I hope I can experience my death with as much integrity and dignity as Karen did, and can let people be there for me in the way that she did. It was a gift she gave her friends and caregivers as much as it was a gift they gave her.

I cried a lot – we all did – but they were tears of release. We would get them out and then get on with what we had to do. Somehow her phones kept breaking, for example. One day she declared, “I’m going to Best Buy with you.” She wasn’t well, so we got a wheelchair. Now, Karen was impossible to shop with in normal times. “Do you like this sweater or that one? Is this sweater too expensive? Maybe I can get this sweater on sale.” At Best Buy, she looked at every single phone. Even approaching death wouldn’t stop this woman from obsessing about whether to get the white or the black phone, the hold button or the speakerphone. Finally I asked her, “Karen, how long are you going to need this phone? Are you planning on taking it with you? You’ve been here for an hour and fifteen minutes. Pick out a damn phone.”

Laughing, she chose one, saying, “Yeah, really. How long am I going to have this phone? It’ll last me eight more weeks.”

***

At Karen’s request, in mid-July I had hosted a dinner party for the friends who had helped her move. She was already in enough pain that she didn’t know if she would make it but she did and seemed to enjoy herself. In mid-August, her friend Jean gave a birthday party for her. The party was forty minutes away so a few of us picked her up in a limousine. Both parties were a celebration of Karen and meant a lot to her but it took everything she had to get through them. Outings had become an ordeal and the party at Jean’s was her last one.

Three or four months before she died, her ankles and stomach swelled so much that it was hard for her to walk, her body seemed out of control, and it was clear that further chemo trials were just prolonging the inevitable. We went to Johns Hopkins to see her oncologist about an experimental drug, and he didn’t see any reason to take it or not take it, but he didn’t have anything else to offer her. She decided not to take it because she couldn’t bear the idea of even more nausea. Nothing they tried seemed to control it.

Gradually our concern changed from “Is Karen dying?” to “What’ll we do for this pain?”

She was housebound for a month and then, when they couldn’t give her the amounts of pain medication she needed at home, she finally went into the Hospice of Northern Virginia, a wonderfully caring organization. The hospice was overwhelmed – it was September 11, 2001 – but they sent a nurse and chaplain to pick her up. Despite enormous pain, she was upset by what she saw happening at the World Trade Center and the Pentagon. “Oh my God,” she kept saying, “all those people are dying!”

The hospice was in a converted elementary school. The room she died in had once been her classroom. She already knew some of the nurses because she had worked at the hospice as a volunteer. Her hospice work had been important to her, and helping people who were dying had helped reduce her own fear of dying. I was terrified the first time I visited—and haunted by the open mouths of the dying, struggling for breath. But as the days passed I was less aware of the look and smell of death and more aware of the patients’ dignity and the tender love family and staff showed for them. A physician had explained to me that he found the work both healing and spiritual. I could now see why.

Karen was in a ward with four other people. A private woman, she suddenly had no privacy. She talked at first about being out of control because people could come any time, day or night, without calling. But the hospice staff was wonderful with her. They have so much experience that they knew what to do to make her feel comfortable: bathing her, putting on a clean nightgown every day, washing her mouth out, trying to get some of the gunk off her teeth. Sometimes I turned my head away because it was so painful to realize that, try as we might to have control over our lives, we are ultimately helpless.

She stopped eating and lost even more weight. She was both skeletal and swollen and most of her hair had thinned and fallen out. She still put lipstick on but her nail polish was chipping off. All her life Karen had had “nail night,” staying home once a week to do her long, beautiful nails. She kept saying she wanted to make lists of things she wanted to give people, but she resisted doing it. “You’ve got to help me make that list tomorrow,” she would say, but she never got around to it. We talked about going wig shopping, but never did. “The hell with it,” she decided. “It’s not important.”

Once a week a harpist came and played right outside the ward door. One such evening, Karen, who had been sleeping, opened her eyes and held out her hand. “Am I in heaven yet?” she asked.

I said, “Not yet, honey. Not yet.”

Eventually she went into a medicated coma. The morning she died, the hospice staff called and said, “Don’t come this afternoon; come this morning,” She died that afternoon, October 3rd, 2001. After she stopped breathing, her heart kept beating another 45 minutes.

***

They say that we die the way we lived and that was certainly true for Karen. After feeling so scared all my life, helping Karen was at least as helpful to me as it was to her. I thanked her for her courage because it became my own. Being phobic and squeamish about illness had always felt self-centered, and when the people at hospice asked me to help someone with a tube and I did, I was amazed at myself. At hospice, the dying and their caregivers were in the same bind and they were all getting through it. Karen dying helped me learn that we would all get through it.

I’ve pretty much stopped being obsessed about whether my cancer is going to return. I’m frightened of it but I really don’t give it a lot of thought. I can’t afford to, because if I did I would be scared all the time. Not worrying about it is a different defense; I’m more realistic and I feel more adult about it. I yell less at my kids now and appreciate the world around me more. I especially appreciate my family of friends, and know we can be there for each other if I am ever in real need.

Copyright by Bayla Kraft. This story originally appeared in the Health Section of the Washington Post. For permission to reprint, please contact the owner of this website (www.comfortdying.com).