Mortality: The Uninvited Guest You Eventually Have to Meet

Our first-ever Q&A! Garrett Kamps talks about his cancer journey, healing and finding the answers to the big questions. Plus, the importance of sandwiches.

Facing death and facing mortality are two very different things and I’m not sure which is worse.

My mother was diagnosed as terminal with pancreatic cancer — the motherfucker of motherfuckers — when I was 19 and she died about seven months later, after I had turned 20. I spent much of the spring semester of my sophomore year living with this cloud that followed me around; a mixture of sadness, guilt for not being home, guilt that it was going to end before her time should have been up¹, guilt for having fun by guzzling cheap booze² and achieving my goals while she was home being consumed by a tumor. That guilt didn’t necessarily wash away with her death that fall. I would characterize it as sort of slow sloughing off, leaving behind a scar that has since faded. If you look closely, you can still make it out³.

My first confrontation with mortality was a few years later. I had just been laid off from my first job, post-9/11, and still living at home. My father required surgery on his neck because a disc in his spine was pressing against his spinal cord, causing pain and various nerve issues. I accompanied him to the pre-surgical consult, where the doctor explained a fairly simple procedure: he would go in through the throat area and shave the disc down to relieve the pressure. Easy enough, right? And then he reviewed what could go wrong, namely the chance of paralysis or death. That evening is when mortality joined anxiety for their first joint house call.

Not my father’s neck.

You know, he’s not going to end up paralyzed. He’s going to die. The doctor will clip the spinal cord and he’s going to go and you’ll be an orphan at age 24.

I called my therapist and took his next available appointment. He reminded me that I was letting the anxiety and “what if” thinking win and he was right. He also reminded me that what I was doing was completely normal given the circumstances. Adult children often prepare for the worst when it comes to a parent so that way they are ready if it happens. From Dr. Jade Wu for Psychology Today:

Understand that worry is your brain’s way of trying to feel safe and in control. Often, people with GAD⁴ believe, consciously or not, that worrying helps prevent bad things from happening. When we worry, we feel like we’re doing something proactive, which distracts us from our feelings of panic or helplessness.

But the idea that worry somehow helps or prevents tragedy is an illusion. Worrying can’t change the situation at hand.

We may also worry as a way of purposely keeping ourselves in a negative mental state. That way, if the worst really does happen, we're prepared for it. This is another illusion the brain cooks up for us. If our loved one dies unexpectedly, we'll be no less devastated if we’ve imagined their hypothetical death many times before.

The surgery was fine; afterwards, he had a sore and scratchy throat for a week or so. Since then, he’s had both hips replaced — more onerous surgeries than the neck thing — and I didn’t pay it much thought as those procedures are so routine. Talk therapy was successful in teaching me how to cope when these things arose.

I haven’t really thought much about my own mortality as I’ve had no medical or physical reason to question it. But, I was lucky enough to find someone willing to chat about how they are fighting back against theirs.

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The Dirt Nap Q&A: Garrett Kamps

I first encountered Garrett Kamps from his interview with A.J. Daulerio at The Small Bow, an email about addiction, mental health and recovery and a Substack I support financially. Garrett writes his own Substack called Healings, inviting readers to follow his journey with cancer and treatment. I highly recommend both of these — you’ll find them listed on the front page.

A.J. connected me with Garrett and he was kind enough to take the time to participate in Dirt Nap’s first-ever Q&A.

For those who haven’t read Healings or your other work, this is your second bout with cancer. Can I impose on you to take my readers through your previous diagnoses and where you are today?

Sure. I was diagnosed with testicular cancer on election day, 2012. For several weeks prior to that, one of my testicles kept getting bigger and bigger. I didn’t think much of it at first, which tells you how little attention I paid to my health back then. But when it got too big to ignore, I called my doctor, this really fantastic human being who helped manage my treatment when I was diagnosed with Type 1 diabetes a few years before, among other ailments. My doctor thought it could be what’s called a “hydrocele,” and ordered an ultrasound. Within 20 minutes of finishing the ultrasound, my doctor was calling me as I walked through the medical center parking lot. He asked me to come up to his office right then, and that’s when he told me the ultrasound showed it was cancer.

Having gone through this a second time, and talked to lots of cancer survivors about how they were diagnosed, it amazes me how quickly I went from ultrasound to diagnosis. Usually, it takes days and often weeks to get enough information that doctors feel comfortable sharing something definitive. In my case, the next day I saw a urologist, and before the week was over I had surgery to remove my testicle — it all happened so fast. I was very fortunate because the cancer hadn’t spread beyond the testicle, so surgery was all I ended up needing.

What is your prognosis?

With my current cancer, it’s what’s called diffuse large B-cell Non-Hodgkins lymphoma. It sounds scary but it turns out it’s one of the more treatable cancers and responds very well to chemotherapy and the immunotherapy drug Rituximab. My disease was “aggressive” and “bulky,” two terms that have particular connotations in the world of cancer. In my case, the latter referred to the fact that the tumors in my abdomen were roughly the size and shape of a bunch of grapes. But my prognosis is good: the cancer was essentially nuked by the chemo, and I had my sixth and final treatment just recently.

The final step will be radiation treatment, which they generally give you when you have bulky disease. The idea is that through chemo + radiation, they’ll root every last little microscopic cancer cell so the disease never comes back. After radiation, I’ll follow up every few months with my oncologists and run tests, and that’ll continue for several years. The rule of thumb with cancer is if it doesn’t come back after five years you’re considered “cured,” so that’s the hope.

The story of your most recent diagnosis reminds me of what happened to my uncle. It was Easter Sunday and I left from my aunt’s house to drive back to my college campus. It was the spring of my junior year. The next day, my father called me and said that he had driven my uncle to the hospital that night because he was in excruciating abdominal pain and my aunt didn’t know what to do for him (call an ambulance, right?). Ultrasounds found tumors throughout his colon and on his liver. Biopsies showed he was terminal and he died that July. In the moment you’re sitting in the ER and the doctor tells you what they have found, where does your head go?

Well first, I’m sorry to hear about your uncle. In terms of what went through my head, I’ve written extensively about this because it’s not one or two thoughts but a whole mess of them. For starters, when the ER nurse first informed me that the pain in my abdomen was due to “masses,” she had zero information beyond that, which is very typical. No one comes out and says, “You have diffuse large B-cell lymphoma with a survival rate of x” — that only happens after days and weeks of biopsies and tests. And so when you hear “masses” and you know zero about cancer generally, let alone what cancer you may or may not have, it’s easy to jump right to the next lily pad, which is: I’m going to die. And that’s its own chain-reaction of thoughts, but in my case what was top of mind was the fact that my wife and I had only just recently found out we were pregnant with our first kid, after more than a year of trying. I remember when I found out I had testicular cancer, in those first couple hours when again you’re thinking all the worst things, I had a kind of equanimity about the whole situation: whatever will be will be. But this second time around I was just crushed, because in that moment, again because I was very naïve and had no information, and so a cancer diagnosis felt synonymous with death, it meant I might never get to meet my kid.

As I type these questions, I’m watching an illustrated GIF of you in a hospital gown on a teeter-tauter with the red devil of doxorubicin. It’s only mildly distracting, if not a little funny, because your entry is about what you sign up for in chemotherapy, as it’s the only real alternative to letting cancer win. My mother was diagnosed with pancreatic cancer and given the choice of undergoing surgery to remove the tumor (not guaranteed to work and likely to kill her due to her condition), chemo (not guaranteed to be successful), or hospice. She chose the latter. Some people, due to their terminality or age, opt to ride off into the sunset. Was that an option that ever crossed your mind?

Again, very sorry to hear about your mother and I hope the sunset was beautiful that day. This was not an option that crossed my mind, no.

How are you managing your own mortality? Not to be a fucking downer, but how have you navigated the topic of your life and death internally and with others?

One of the things I thought might happen once I emerged from the fog of those first weeks of extreme illness and then treatment, and especially after I started writing about it, is that I’d sort out all my thoughts on mortality, spirituality, and death and then start spreading the good news of what I figured out. Well, this didn’t happen.

The other thing that’s interesting is that the further I get from those few weeks when I really did think I could die — the more I drift back toward normality, and mundane questions like what’s for dinner and whose turn is it to do the dishes — the less I feel the urgency around sorting out those questions. I don’t think that’s a good thing exactly. I’m not saying it’s necessarily healthy to go around contemplating your death all the time, but neither do I think it’s healthy to ignore it either. So some kind of balance between those two would be ideal, and I’m working on trying to find that — to give myself the space to heal and not put too much pressure on myself to answer these big questions, but at the same time not just put them off indefinitely either.

When did you have your first visit with mortality? I saw you refer to him as the “mortality guy” in your interview with Chuck Prophet?

Really the first time was my testicular cancer diagnosis, during that first 24-48 hour period of uncertainty. When I was diagnosed with Type 1 diabetes a few years earlier, it jolted me out of this period of blissful unawareness of my body, made me realize that it’s not just some perpetual motion machine that’ll keep working indefinitely no matter what I do to it. But with Type 1 diabetes, it’s not like a death sentence — it’s a chronic condition that you have to manage every day, but eventually you get used to it like everything else. But for all kinds of reasons — one being it kills a lot of people, and another being most of us are hopelessly naïve about it as a disease — finding out you have cancer really does feel like a death sentence. For better or worse, it gives you the opportunity to actually contemplate your demise, oftentimes for the first time ever.

You’re alive, full of foreign cells and chemicals, but alive. Do you have a message for the mortality guy?

Not so much for the mortality guy, aka the grim reaper, because that’s not really how I conceive of these things. But if we’re just talking about a more general message for anyone reading who might be scared of death or dying or illness or anything like that, I think Warren Zevon said it best: Enjoy every sandwich.

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Share your story…

See, it’s quite painless to bare your vulnerabilities. But seriously, I want Dirt Nap to be interactive, so if you’re interested in sharing your grief story, I’m here. Write an essay, contribute a poem you’ve written, or step up for a Q&A. Just send me an email to jaredpaventi at gmail dot com and let me know that you are in. You dictate the tone and form, and I’ll be the guide.

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Final thoughts on finality…

1. It’s a vague and trite phrase, I know.

2. You mean that the alcohol in plastic bottles isn’t good quality?

3. Hi. I’ve written six editions of this newsletter and five of them have made reference to her death.

4. Footnote is mine. GAD is Generalized Anxiety Disorder, which was one of the things I was seeing a therapist for.