Homage

Charlie died two days ago. He was a patient of mine for the past two years and we wrestled together with the complexities of multiple myeloma and its management. He was more than a patient. He was a good friend.

When I first met him, I was struck by his name. A former medical school professor of mine and later a physician I had the honor to call a colleague had the same name. It turned out Charlie was his son; hence the entree to shared experiences and friendship.

Charlie was very successful in his own right. He was married to a beautiful and very bright woman and had lovely children from a prior marriage. He enjoyed fine wines and traveled to Paris and Barbados regularly, often to avoid family hassles with the holiday seasons. And so it was particularly hard for Charlie to face the need to constrict his wonderful life and bend to the whims that myeloma and its treatments brought. For example, one of the drugs employed in treating myeloma is Revlimid. Although a wonder drug with startling success in this disease, a nasty side effect for some patients is uncontrolled diarrhea that is episodic and unpredictable. Poor Charlie was caught on busy Manhattan streets too often with this predicament thus curtailing some of his enjoyable outings to restaurants and NYC nightlife.

He witnessed success with several therapies and, in part because of his professional interest in biomedical companies, he kept abreast of the rapidly changing landscape of therapies for multiple myeloma. Very unfortunately, Charlie developed a complication of the disease, kidney failure which itself is fatal unless one chooses hemodialysis or renal transplantation. He was not a candidate for the latter in view of his age and cancer diagnosis.

As a physician I was struck by the juxtaposition of his predicament and the emerging information about brand new therapies that portend even better control and survival for myeloma patients. Charlie’s myeloma remained under good control but he was facing death from kidney failure. The intellectual conundrum was startling to me. I had a patient with a disease for which wonderfully exciting therapies continued to be developed. He was alive and knew I had recently returned from a medical convention where three new drugs for myeloma were just FDA approved and exciting new approaches employing our native immune system to control myeloma were revealed and discussed with a great sense of excitement. Only now I had my patient facing the existential decision to cope with kidney failure by taking on hemodialysis, a process that would severely curtail his quality of life, or choose to die comfortably but knowing he would not die of his cancer. The new therapies promised control for many more years and perhaps cure. What a difficult problem!

My patient chose well. I cannot imagine with clarity his thought processes but among his considerations were his daily quality of life or lack of it and family matters. I was privileged to visit him at his home as he lay dying. He had been able to speak with clarity individually with family members and he knew with certainty that his loving wife would attend to his every need. His death was peaceful and dignified and a sure reflection of who Charlie is.

It was a great honor to know him and serve him. May his passage be bountiful and peaceful.