It Might Get Messy

We’ve talked about Ulysses S. Grant here before. Now’s a good time to revisit Grant, and dig a little deeper into his death.

But first, his life. His name was actually Hiram Ulysses Grant. The Congressman who petitioned him to West Point as a favor to his father simply misstated his name on the letter of recommendation. Grant argued, but the U.S. Army bureaucracy could not be moved. Ulysses S. Grant he became [1]. 

I’ve always felt a kinship with Grant. He lived a sort of existential life, with ups and downs that were largely driven by factors beyond his control. He worked hard, hammered at problems until he solved them, was devoted to his family, and recognized opportunities. Otherwise, he rather sat on the inflatable raft while the ocean of life moved under him, sometimes dumping him off, sometimes propping him up just when, say, the U.S. needed to have Vicksburg fall, Lee’s army could finally be defeated, and the country needed a sensible President. 

He did smoke cigars. Lots and lots of them. During the war, I expect, he smoked pretty much constantly. He couldn’t drink to relax. He had a complicated relationship with alcohol. Historians remain divided on this issue even today. It appears that he was one of those people whose physiology didn’t process alcohol well, so that a small quantity pounded him. Despite the existence of some contrary sources, he largely quit drinking when he realized its dangers for his particular biochemistry. And he definitely avoided alcohol when there was a lot of metal on the table—before key battles in the war, and during his Presidency. 

He had a house at the Jersey Shore, in Long Branch. His throat cancer announced itself in the summer of 1884 when a ripe peach and a glass of water caused him sudden and intense pain. It was a bad time for his health to fail—he was in deep financial difficulties, having been conned out of the savings from his Presidency by a seedy investor. But. He had just started to write and publish well-received articles in popular magazines. Mark Twain had a start-up publishing house, and offered him a good deal for his memoirs.

He started writing sometime in the autumn of 1884. Twain got him a couple of researchers and the editing was done in real time. As he finished a block of text, it went off to be edited while he tackled the next one. During the spring his pain increased, it was difficult to function. The doctors came up a way to make him as comfortable as possible while still allowing him to work. During the day, they gave him cocaine-based pain killers. At night they switched to opiates. 

It worked well. Smith says “In extreme pain and often groggy from medication, Grant wrote 275,000 words in less than a year. The thoughts flowed steadily from his mind to the paper.” He died on 23 July 1885. With a truly melodramatic flair, he had handed the assistants his last re-writes just days before. The book was an enormous critical, financial, and historical triumph. U.S. Grant rode the peak of a good wave to the end of his life. 

Somewhere down below I’ll sort out for you my (possibly appearing grossly and unjustifiably egotistical) belief that Grant and I share more than rampant throat cancer. For the moment let’s sort through my physiological condition. Some of you have had an email briefing on status of the civil war raging here in Cancer Land (copyright, trademark). But things are pretty complicated. Please stay with me a bit here if you can. 

The landscape here is bleak. On Tuesday I had a PET/CT scan, radiographic imaging administered by a tattooed woman with a nice little nose piercing. She’s kind of aloof, but I’ve established a good relationship with her over the past 4+ years. I’m guessing her “good luck” as she handed me a CD copy of the imaging data was sincere. And also that she was shocked by the output as the 3-D composite of my head and torso built itself on her monitor.

Here’s the deal. There’s a big-ass spot of white-hot radiosugar uptake in my throat. I was mistaken about this last week. I thought the doc could see this area via the endoscope and had dismissed it. In fact, it was masked by the mess of blood and mucous that now occupies my battered head and neck. The radiation hotspot means the constant bleeding is coming from a nasty, large and aggressive malignancy right there where the war began so long ago. 

Then there are my lungs. 6 or 7 streaks of diseased tissue, both left and right lungs are involved. 

And my liver. A malignant slab occupies the upper edge of one of the larger lobes.

Finally my lymph system. Or what’s left of it. Remember a couple years ago they had opened my chest up and tried mightily to excise all lymphatics in the vicinity of the tumors. The cancer won that battle.

In brief, I’m screwed. The older, vastly experienced surgeon who’s been seeing me the past couple weeks said (and this is a quote) “…people in your condition have months, not years, of remaining life.” I’m glad he was willing to be so brutally honest. This also explains the asthma-like symptoms that have been worrying me the past few weeks. My lungs are indeed sick. 

On Wednesday, we’ll see Dr. H, the young surgeon who has helped me fight this war from the first skirmishes. We’ll be discussing the menu of malignancies, and make some choices regarding how I want to die. Because I think there are some options that give us a little flexibility. The lung tumors may be susceptible to certain chemotherapeutics that would slow their growth. The mess in my throat may be amenable to surgery or a focused attack of high-dose radiation. It cannot be eliminated, but it can be temporarily suppressed. The liver I’m afraid I don’t know much about at this point. Livers are physiologically active, though. It’s possible they could slice off the diseased hunk and force the cancer to reconstitute itself before becoming symptomatic. 

So I my have choices. None of them are “good” in the sense of a favorable long-term outcome. But it’s possible that I can maintain a reasonable quality of life while we wait for the hammer to fall. We’ll go over all this with Dr. H on Wednesday, so check back here next week for a more focused update. Also, a number of you have responded to my request for things I can do for you while I’m still functional. Several people requested a compilation of Thanksgiving writings. Highly esteemed Alexander M put together precisely that compilation last year. So I will deconstruct his wonderful scrap book, run off copies of all the material, and put together some binders of Thanksgiving invitations and affiliated materials. Others wanted me to visit my photographs, and provide a selection of the best. I’ve already started going down this road. I’m working on digging out my 35 mm slides to have them digitized, and I’ve been sorting the photos on my extant hard drives. I believe I can get a vanity publisher to put together an album at a reasonable cost. I’ll explore such options. 

In the meantime, my friends, the best thing you can do for me is to have a dynamite summer, seeing and doing things that need to be seen and done. I now live vicariously through you. And I won’t be living much longer. Dr. S, crusty old surgeon, says an average time-to-death of people in my condition is 13 months. I don’t think I have that long. My lungs are already getting wheezy, which means those malignancies are active and aggressive. But we’ll see. We’ll talk it out with Dr. H on Wednesday and I’ll keep you plugged in to what’s going down. 

Live ‘em while you got ‘em, all. They aren’t forever. But they sure are sweet while we have them!

Oh yeah. Grant. Typical for me, I have about 15 writing projects open and on the desk top. Realistically, I have to do some serious triage. I think I'm going to focus on the rock and roll book I'm writing with Beth. It's a really fun project, and will have some value for you all even if I don't live to see it completed. But maybe Sam Clemens has some spirit left to pump my way. I think, had he been alive when Buddy Holly hammered that first chord onto vinyl that let everybody hear it, he would have been enthralled. I'm no Mark Twain. But I can write, and I got rock and roll in my blood. So rock on, all. Can guitars protect us from the cold and dark of the inevitable, entropy-driven universe? There's only one way to find out!

Notes

[1] An excellent, readable biography is that by Jean Edward Smith, titled simply “Grant”, published by Simon and Schuster Paperbacks in 2001. The name screw-up is addressed on page 24.