About two months ago,, my friend Virginia's neighbor and friend, Joe, suddenly found himself in my position, being diagnosed with stage four kidney cancer that had metastasized into his bones.  One moment his life was routine; a minute later nothing would ever be the same.  In my case, it was the left scapula and its refusal to heal normally that signaled something was wrong.  For Joe, the experience was like that of the protagonist of Tolstoi's classic story "The Death of Ivan Ilych":  Ivan is the most ordinary of men.  One day, doing the most ordinary of household tasks, he "bruises" his side.  He thinks it's nothing, but it doesn't get better.  While the doctors and his family focus on his external health (and the inconveniently altered routine of their lives), Ivan broods on his own past and present, as well as his very short future.  Joe also hurt his side, a minor injury, he thought, that would heal quickly.  But it didn't.  It was more than a bruise; ribs had fractured.  Why from such a small accident?  It didn't seem logical after his having lived a physically active, healthful life.  And then came the diagnosis: kidney cancer (like me, Joe had never had any signs of a problem with his kidneys) that had spread.

Virginia keeps urging both Joe and me to call each other and exchange information.  So far, neither of us has done so.  And it would be interesting to know which chemo Joe is taking and at what dosage, whether he takes the bone-strengthening shot that I take every three months, whether he gets a daily shot to prevent or ameliorate the pulmonary embolisms that often result from cancer.  Joe went to the country's premier hospital for cancer, M. D. Anderson.  What regimen did they prescribe?  Does it differ from mine?  And then perhaps I could be an example for optimism, as someone who has outlived his prognosis by two years now.  And if the conversation stopped there, it would have been a productive exchange.

But might there also be a downside to meeting?  If Joe is angry at life's unfairness, how much more unfair might it seem that I, who certainly can't attribute the extra two years to clean living, am still alive and kicking?  Joe never smoked; I did--and do.  And we would certainly talk about the side effects and the practical reality that Joe's life is going to be "diminished"--and that this change isn't going to get better.  In my case, the first effect was to drive my blood pressure way up, requiring three anti-hypertension medications, each with its own additional side effects.  And then the fatigue, which will change the entire rhythm of his days.  Every time I mention it to my oncologist, he says the same thing:  "You have to remember that your body is fighting cancer and that you're introducing toxic chemicals to combat the cancer into your body every day."  That's clear and accurate, but hardly a consolation when every three hours your mind and body turn themselves off.  For Joe, who has always been physically active, how to say this is just a fact, a new constraint that is never going to change.  And then, of course, almost everyone who takes chemo suffers from G-I problems--nausea or diarrhea or loss of appetite or all of the above.  If a talk were to take place, despite my longevity and seeming energy (timing of meals and visits is important; better if only Mohamed sees the ugliness), we'd also have to discuss what the next months or years are going to be like. 

So far, Joe and I haven't met, and I seem to be talking myself out of calling him--and thinking up all sorts of rationalizations to justify not doing so.