The Big Endgame

The purpose of this essay is to pass along some insight gathered from my personal experiences with retirement and cancer.

I turned 65 years of age this year- I was born just a few weeks before the launch of Sputnik. Attaining this age brings before you what you may have already known about your fate all along. Once here, however, what were fuzzy abstractions about the final chapter now stand squarely in front. That would be retirement. Yes, it’s real and yes, it’s time has come. My aim is to retire in late spring of 2023.

In chess, the endgame often consists of a board with a few pawns, two kings, and maybe a knight, bishop or rook or two to maneuver. At this stage, the king can be used offensively to threaten your opponent and advance a pawn for promotion to a queen. Pieces previously thought minimally useful suddenly become the key to victory. So too in retirement we can find ourselves limited by finances or health and are forced to finish the game with what limited resources we have left from our once green pastures.

By retirement, most people have had plenty of time to review their past triumphs and mistakes with a perspective that only extended time can provide. It is all too easy to spend one’s final years filled with regret for opportunities lost. This is a poor way to run down the clock. Anything that prevents us from appreciating the wonders of the universe is true misfortune. Wonders can include our loved ones, memories of past experiences or the marvels of nature. Being a secular humanist, my theory of the universe is limited to that covered by physics.

As I have grown older, I am increasingly aware of the need to leave behind resources for my family. It is more complicated than just leaving a last will and testament for the distribution of my estate after my death. In the United States, there are whole industries whose goal it is to extract as much wealth as possible from a person’s illness and death. Foremost in that group is our system of health providers. The overhead costs of this industry includes very expensive labor and equipment. Worse, the economies of scale are bogged down by the need for personal, one-on-one treatment. A health-related slow death is very expensive. A heart attack can, but not always, lead to a very rapid death. Cancer often leads to a very slow death.

It turns out that I was diagnosed with two stage-4 cancers in 2013- throat and prostate cancers. I won the goddamn lottery. I’ve had chemotherapy and radiation for both cancers and it was largely successful by the way the medical profession measures success. My type of throat cancer was highly treatable, but not so much for the prostate cancer. All that can be done is to stunt it and buy time. Unfortunately, neither cancer is associated with a rapid death. Of the two, the throat cancer was virally induced and is the one that poses the least threat. However, the stage-4 prostate cancer is a problem. Luckily, the PSA blood test affords an easy way to follow its progress. Histopathology is very important for identifying particular subtypes of cancer which may have very different outcomes.

You might think that extensive medical training allows oncologists to “wing it” when it comes to treatment. Actually, there exist flow charts that are used to diagnose and direct treatment of cancers.

I went to a university hospital because I guessed they were most likely to have the most cutting-edge treatments available. Plus, I thought, there would be the chance to try experimental treatments. I was wrong on both accounts. The one outstanding thing they do have, however, are faculty with MD/PhDs such as my oncologists. Reasearch active faculty plus a stable of students and residents. What I like about this is that they have a weekly “tumor board” meeting where every case is put before a room full of experts. I don’t have any statistics to back up the actual value of this, but I like to think it’s an advantage.

As far as experimental treatment, having 2 cancers was disqualifying for any study. Bummer.

Back to the endgame. One way to extend your life with cancer is to liquidate all your assets and throw it at layers of treatment. Many people do this and the health care industry is happy to get the business. Afterall, it is a business with costs and obligations. While some politicians pay lip service to the outrageous costs of health care, they have serious obligations to their donors. Especially the large ones. As with all capitalism, the price of service is what people are willing to pay. A substantial fraction of medical costs are covered by insurance or medicare. So, prices are what these organizations are willing to pay. The patient is not the real customer in the conventional sense- only a hapless passenger on a boat taking on water.

The financial realities in having a long-term fatal illness often lead to impoverishment or something close. Cancer is known for cycles of treatment and remission. I have been in remission since about 2014. Frankly, based on my research I thought the prostate cancer would have killed me by 2020. However, the recent growth in my PSA test results will cross the 4.0 level in about 1 year so I am near the end of the first cycle. It is common for successive treatments to be less successful that the previous ones.

So, the big question comes up. How many treatment cycles is “enough”? When do you throw in the towel? Of course, that is hard to say. It depends on many factors and must be played by ear. Is refusing treatment tantamount to suicide? Are we sure that this kind of suicide is a bad thing? How will loved ones feel about your refusal to continue treatment? Is spending $100k from your estate to get another 3 months at the expense of your heirs really worth it? Perhaps that $100k is better used by your kids as a down payment on a house. Choices, choices … One thing I’m sure of is that if you die during treatment, you probably went too far.

One of the problems of health care costs with cancer is that resources are funneled into increasingly expensive and futile treatment rather than passed along to the survivors. I’m wrestling with this matter now. A long life is desirable, but not at the cost of denying my family a decent chunk of my estate with all of the opportunity that it can bring.

My state of Colorado has legalized cannabis. I plan on being stoned as much as possible through the endgame. Why be sober when you can explore altered states of consciousness during this unpleasant exit?