by Richard Ault
For five weeks last winter, I walked a half mile each morning
from the "nut house" to my cancer treatments.
Munson Manor sits at the border of the campus of the Munson
Medical Center and the old Michigan State Mental Hospital campus in Traverse
City. When the mental hospital officially closed down in 1989, after years of
slow decline, it was designated an historic site and preservation efforts
resulted in what is currently known as The Village at Grand Traverse Commons.
Munson Manor, now a gracious "guest house" for hospital outpatients
and their families, was originally just plain "Building 27", built in
1903 for female mental patients.
Although we live only about an hour away, what with the
vagaries of a Michigan winter and the potential for hazardous driving, my wife
Pennie and I decided we would rather remain near the hospital for the five
weeks of my chemo/radiation treatments and chose to stay at the Manor House.
Traverse City is the heart of one of the most beautiful
regions on the planet, situated in northwest lower Michigan at the base of
Grand Traverse Bay off Lake Michigan and surrounded by beautiful inland lakes
and idyllic towns and villages—a tourist mecca and increasingly a magnet for
retirees. Among these retirees, my wife Pennie and I live nearby on pristine
Torch Lake. However, as a kid growing up in the 1940s about three hours south
in Saginaw, I and most of my friends knew Traverse City simply as the "nut
house." As the location of one of the three state "mental
asylums," it was where they sent the crazy people. "You should be in
Traverse," was an insult we used when one of us said or did something we
thought a little wacky.
But that was just the beginning of my long experience
with this place.
As an undergraduate at Central Michigan University in the
late fifties, I was a double major in English and Psychology, taking a class in
Abnormal Psych as a junior and Clinical Psych as a senior. Each year the
combined classes took the two-hour bus trip from our Mt. Pleasant campus to the
mental hospital in Traverse. We first met in a large conference room and were
introduced to a few of the "milder" neurotic patients, who were
interviewed by hospital staff and then took questions from our group—sometimes
fascinating but fairly tame stuff for the most part. But then came the real
horrors of the place. We toured some of the most disturbed wards and witnessed
firsthand every form of psychoses imaginable—a scene reminiscent of the
infamous Bedlam asylum in London. My gut churned. My mind swam. I concluded
that I would rather be dead that suffer serious mental disease.
And then came my dad.
Several years after those field trips, my mother and father,
both in their late sixties, were stricken with serious cases of the flu and had
to be hospitalized in Saginaw. My mother emerged without further issues. But
not my dad. Mentally he was completely fried and put in the Saginaw County
Home. Soon I received a call in Kalamazoo, where I was living at the time, from
my brother Chuck to come to the Saginaw facility for a "family
meeting." We never had "family meetings", so I knew it was
serious.
It was the first I had seen Dad since before his bout with
the flu and it was awful. He was completely incontinent, wearing diapers, and
hallucinating. We, his five sons, were told he was violent and uncontrollable
and would not be allowed to stay there. He had never received a formal
diagnosis to explain his condition. The
five of us discussed his options. My four older brothers carried most of the
conversation, not a surprise as I look back now given that I was ten years
younger than my next closest brother. Finally, we voted reluctantly but
unanimously that the State Mental Hospital in Traverse City was our only
option. Though my brain was flooded with the haunting scenes I had witnessed
there as an undergraduate, I fully respected and agreed with my brothers'
conclusions.
I only got up from Kalamazoo to visit Dad twice. The first
time I rode from Saginaw to Traverse with my oldest brother Jack. We sat with
Dad briefly in his ward, a scene much like I had seen in my previous student
field trips—scary but perhaps not quite so extreme—or maybe I was just
witnessing the place through less innocent eyes. Jack then arranged for us to
take Dad out for a short car ride. Along the way, we stopped for ice cream
cones and then parked to enjoy them near a beach with a nice view of East Grand
Traverse Bay. Dad was in the passenger seat while I was in the back. Jack—who
was so much better at this sort of thing than I was—tried to engage Dad in
conversation about old times, old relatives, and other normally familiar
themes. Dad seldom said anything, and when he did, his comments were not very
responsive. Then suddenly he opened the car door and tried to take off. We got
him back in the car but the ride was over. Back to the mental hospital.
The second and last time I saw my father, Pennie (my wife to
be) and I drove up from
Kalamazoo for the weekend. On Saturday, I met my brother Jim
and his wife Arlene at the hospital and the three of us sat with Dad on an
enclosed porch adjacent to his ward. I remember little of what we talked about
except that several times he complained that someone had been hurting him
physically, maybe an orderly. Given his state of mind, we did not know whether
to believe him or not. How could we know—he was crazy after all. At one point,
out of the blue, he got up from his chair and stood over me. He stared down
with a menacing glare as though ready to punch me. Did he take me for his
tormentor? Although I had been on the receiving end of his anger more than once
as I grew up and remained afraid of him at that moment, I didn't flinch. I
stared back directly into his hate-filled eyes. Thankfully, he backed off and
returned to his chair. We took no action on his complaints about physical
abuse.
The weekend was salvaged when on Sunday I took Pennie for a
drive around Torch Lake. She fell in love with the shades of turquoise on Torch
that day, and though it would take years to make it happen, we had found our
future home. Soon after our Traverse visit Pennie and I were married and moved
to Atlanta, Georgia, where about a year later we received the call that my dad had
died.
My niece, Connie Ault Kinnaman, has become a passionate
family historian, our own genealogist. She made the unfortunate discovery that
it was not just my father who died from an extreme case of dementia, but so too
did my great grandfather, my grandfather, and a grand uncle, all at the
Traverse City State Mental Hospital. In those days, the disease was most often
known as senility or hardening of the arteries. We can’t know for sure if it was Alzheimer's. As knowledge
about the disease has advanced in more recent history, however, we do now know
that three of my four brothers were diagnosed with Alzheimer’s, as well as
three cousins from my dad's side of the family.
While only a small percentage of Alzheimer's cases are
thought to be genetic, with my family history I am not comforted by those odds.
Until my very recent journey with cancer, the Alzheimer's specter loomed as my
only serious health concern as I have aged. I was known to boast that I was the
youngest seventy-nine- year old on the planet—at least that I felt that way,
leading an active life with no frequent aging issues such as heart disease,
diabetes, or high blood pressure.
Despite my claims to good health and fitness, though, I have
had a long, rather unfriendly, relationship with my gut, routinely suffering
heartburn before new medications virtually eliminated that problem. However, I
continued to have frequent night time bouts of acid reflux. That led me some
years ago to get an endoscopy, which revealed that I had a condition known as
"Barrett's esophagus," in which the lining of the esophagus changes
to tissue which is more like the lining of the intestine. About ten percent of
us with chronic GERD symptoms develop Barrrett's, and, while it does increase
the chances of developing esophageal cancer, my doctors assured me that less
than one percent of people with Barrett's esophagus develop esophageal
adenocarcinoma.
Nevertheless, I continued to get regular routine endoscopies
every three years with no signs of cancer. Until, that is, in November 2015,
when my doctor found a tumor near the juncture of my esophagus and my
stomach—esophageal adenocarcinoma. So much for those odds. As my doctor
attempted to inform me what I now faced by way of a treatment plan, I could
scarcely hear, let alone understand, what he was telling me. My brain and my
stomach were swirling. The good news was that the cancer was diagnosed early,
before I had experienced any of the usual symptoms such as difficulty in
swallowing or unintended rapid weight loss.
The first thing I did when I got home was call Max. Dr. Max
Wicha was the founding Director of the University of Michigan Cancer Center and
is now Director Emeritus. He and his wife Sheila were once our summer neighbors
on Torch Lake, owning the cottage next to ours. Max, a world-renowned authority
on breast cancer, is also one of the nicest guys I know, and I have long said
that, heaven forbid, if I or anyone close to me would ever develop cancer, Max
would be the first person I would call. And I did. He told me that their center
had one of the best esophageal cancer groups in the country, headed by Dr.
Susan Urba. The next day, I received a call from Dr. Urba, a most informative
but gently reassuring call. She arranged for me to meet the next week with her
and a surgeon, Dr. Rishindra Reddy, to discuss my options.
On December 29, 2015, after a few weeks of tests and further
consultations, I had all but the top inch or two of my esophagus removed by Dr.
Reddy at the University of Michigan. The procedure also involved stretching and
pulling my stomach up to my neck to be reattached to the little bit of
remaining esophagus, permanently and radically changing the way I must eat. The
surgery was a success and we "celebrated" by spending New Year’s
recovering in the hospital. As is standard practice, seven days later I was
given a barium swallow test to determine if there were any leaks in the new
attachments. I passed with flying colors. No leaks. Normally that would mean
hospital discharge and going home the next day; however, the surgical team that
appeared at my bedside early each morning noticed that the dressing on my neck
incision showed more dampness than they were happy with, a likely indication of
some minor leakage. They tried to find a leak by observing me take a drink of
grape juice or water each of the next three mornings. No leak. Then, on my soft
food diet, one morning I had some yogurt and soft slices of mandarin oranges.
When I followed that by drinking some water, my incision let loose and I began
to spray through and around my cervical dressing. When I asked Dr. Reddy how it
was that I developed a leak despite passing the barium swallow test, he told me
it happened about five percent of the time. Those were the odds.
The good news was at least they had determined what the
situation was. The bad news was that I had to go home with a feeding tube, able
to take nothing in by mouth. Pennie was quickly trained on how to change the
dressing twice per day and to provide my medications and nutrition through the
tube. We went home the next day with an IV pole and pumps and boxes full of my
"formula." In a few weeks, my untrained but loving nurse Pennie got
me through. The incision leak healed, and we were ready to move on to the next
stage: chemo/radiation at the new Cowell Family Cancer Center at Munson
hospital in Traverse City. Just prior to starting chemo I was given a new CAT
scan, which showed that I had no signs of cancer anywhere—no lymph nodes, and
no other organs. We celebrated by going out for pancakes.
Soon I began five weeks of treatments—chemo each Monday and
radiation Monday through Friday of each week. I feared the worst based on
stories I had heard about the possible side effects of those treatments. Why, I
asked my medical advisors, if my tests showed no cancer, should I go through
such an onerous ordeal? Their answer? To increase the odds—the odds of being
and remaining cancer free based on probabilities from statistical studies.
So, for five weeks, five days a week, through March and early
April 2016, I walked the half mile from Munson Manor to the new Cancer Center
across the street from the Munson Hospital: radiation at 8:30 Monday through
Friday and a chemo infusion on Mondays.
Thus, I found myself back in the nut house. That is, each of
five Sunday evenings we voluntarily checked-in to the old "Building
27", now rechristened Munson Manor, until the following Friday. We slept
there and ate our daily breakfasts and other meals there. Beth and Char, the
day and night managers respectively, and the rest of the staff could not have
been more gracious, professional, and accommodating. The elegant furnishings
and quiet halls created a restful atmosphere perfect for patients' families.
Because we all fixed our meals in the same kitchen and ate in the same dining
room, and because the only televisions were in the public lounge on each floor,
we met and got to know other guests.
Richard, with colon cancer, and Bill, with rectal cancer,
were there, like me, for chemo and radiation treatments. Women with husbands
and men with wives who were in for back or colon surgery. Two new mom's whose
premature babies were still in the hospital, breast pumps sitting in the
hallway outside their rooms so that they could continue to nourish their little
ones. Another mom whose full-term baby was still in the hospital because he was
born with pneumonia. Then there was the family of a teenage girl, a high school
senior, who was brain injured when, worn out from her day in school and her
full-time job, she fell asleep at the wheel of her car and crashed into a tree.
Part of her frontal lobe had been removed to relieve pressure and she was put
into an induced coma. After a few days, she was taken out of the coma briefly
each day and her mother told us how exciting it was the day her daughter first
squeezed her hand. The family could not afford the thirty dollars per night to
stay long term at Munson Manor, and we and other guests quietly helped them
financially as much as we could. The girl's young sister proudly told us how
she enlisted several churches in their small town in offering prayers for her
big sister.
Each morning I walked from the Manor to the beautiful new
cancer center, and, because it was still winter in March and early April, most
days I took the short cut through the hospital. As I walked the long main hall,
I always mindfully noted the painting at its end—a portrait of James Decker
Munson, the first superintendent of the "Northern Michigan Asylum"
from 1885 to 1924. He also donated, in 1915, a boarding house to be used as a
community hospital, now grown into the regional Munson Medical Center. Every
day but Monday, I showed up a few minutes before my 8:30 a.m. radiation appointment.
I was in and out in five minutes or so, free for the rest of the day. On
Mondays, I hung around for the next few hours for my weekly chemo infusion with
Tina, my pretty, funny, and caring infusion nurse. I was usually finished by
about noon when Pennie and I went out for lunch. No signs of nausea. No other
side effects. Not so lucky to get cancer in the first place, I was, despite my
worst fears, very lucky with my treatments.
Each afternoon I took a mile or two walk around the grounds
of what once was the asylum, now The Village at Grand Traverse Commons.
My first time back at that place after my father's death was
several years ago when Pennie and I tried out Trattoria Stella, then a
relatively new upscale Italian restaurant in the old Building 50, which was the
central building of the old mental hospital and, which is still called Building
50 in its current incarnation. The restaurant is in a lower level, almost like
a rathskeller, in what was once the place where they did lobotomies. As we
walked from the parking lot to the restaurant, I looked up at the tall windows
of the old building, the one I visited in my undergrad psych class days and the
one in which I'm quite sure my father died. My mind was haunted by the horrors
I had seen there and what had happened there. My stomach churned all over
again. I told Pennie I wasn't sure I could eat at all. But I did. And it was
good. Since then, Stella has become one of our go-to spots for special occasion dinners such as
birthdays and anniversaries.
In 2008, I took Pennie to Building 50 for her foot doctor
appointment and, as I sat in the waiting room, I tried to stream Tiger Woods in
the Monday play-off for the US Open that he won playing on one leg. Building 50
these days also houses the Mercato shops, art galleries, and other offices. We
have been to Traverse City Film Festival parties there, on the lawn, in the
building, and under large party tents. There is also a yoga studio, a bakery,
and other eateries. Nearby buildings have been renovated and made into upscale
apartments and assisted living facilities. New buildings have sprung up.
Obviously, my feelings about the place have eased. As I went
through those five weeks of treatments and daily walks around those grounds, I
consciously tried to look at those buildings through a new lens. Epictetus may
have said if first—"It is not what happens to you, but how your react to
it that matters," but today that bit of wisdom is even shared by football
coaches and golf pros. I decided I would try to put a new, less- haunted frame
on my vision: this was no longer Bedlam but a setting for growth, for renewal,
for living. Sad to say, I was only partially successful in my reframing.
For me, when I looked up at the Disney-like spires, I still
often saw the past. Looking up at those tall windows in which the bars have
been replaced by mullions, I still often saw the bars. Despite all the best
efforts at transformation I frankly still found it a bit creepy. I will grant
renewal—important enough in itself—but not transformation.
The same might be said of me, of course. My life has been
changed by cancer, by the drastic reconfiguration of my digestive tract
resulting in a radical change in my eating habits that will last the rest of my
life. All observable evidence shows that I am now cancer free. For five weeks,
we treated a disease we no longer knew I even had. I had now done everything
that I could do, my doctors did everything they can do, and together we did
everything that medical science says we should have done to ensure that I am
and will remain cancer free for life. But there are no guarantees—despite the
odds.
So, things are different for me. I must adjust, they say, to
"a new normal." But am I, myself, different? I am grateful, of
course, that I no longer have cancer, grateful that I am still alive. I am
grateful for the doctors and nurses and technicians who provided such superb
professional care. On the other hand, I was already mindfully grateful for my
life before any of this happened—for my family and friends, for a creative and
meaningful work life, for all the fun and satisfaction I have experienced along
the way. It was not new for me that I am in love with life—not just my life but
with life itself—with the very idea of life. I want stay around to continue to
savor life in all of its manifestations as long as I can. I am grateful that my
recent journey will enable me to do that for a while longer.
But am I transformed? Not really, I think. Will I, as I know
I should, live each day to its fullest? Probably not. Will I spend more time
than a sane man should practicing my golf game against all odds of improvement?
Probably. Will I waste too much time on Facebook and watching television?
Likely. As I try to savor the present moment, I drag all of my past along with
me, for better and for worse. The same might be said of the The Village at
Grand Traverse Commons.
Perhaps transformation is just the wrong metaphor. A better
notion might be "transition" or "a work in progress." We,
these old grounds and my old self, are not what we were and we are not what we
are going to be. We don't even know what that is. Buddha taught that all is
impermanence.
So, I find myself with a strange, almost ineffable connection
with this old place. I also find it a hopeful one. We are both changing for the
better, I hope. We are both, in a way, healing. Nearing the end of my chemo
treatments, while sitting in my infusion chair, I read an old Time magazine cover story, "The
Alzheimer's Pill: A Radical New Drug Could Change Old Age." Maybe
Alzheimer's itself will not be with us permanently. This much I know: unlike
some of those of my lineage, I was not "sent to Traverse" to die. I
went there so that I could go on living
I lost track of Richard, the colon cancer patient I came to
know at Munson Manor, but I have spoken by phone a few times with Bill: his
rectal cancer is gone but he must wear both colostomy and urinary bags for the
foreseeable future. Nevertheless, he expressed happiness that he is cancer
free. All the babies who were hospitalized came through healthy and well. The
high school senior with the brain damage graduated with her class in June.
One May morning about a month after all my treatments were
over and I was feeling fully recovered from my winter's troubled journey, I
took my place in "easy seat" on my yoga mat to begin my regular
class. Without a thought, without a moment's warning, I began to tear up. It
snuck up on me from just below the surface. Pure emotion. Pure sensation. No
words attached in that instant, but as the moment passed I realized it was some
combination of joy and relief.
I was still alive, and what a wondrous thing that is.
Richard
Ault
has been a participant-observer in the practice of changing the culture of
large organizational systems for most of his working life. Previously he was a
teacher and principal at the secondary school level and taught both
undergraduate and graduate level courses at the university level. He was
principal author of a book on change management called What Works and has published articles,
poetry, and short fiction. Consistent with his life's passion for change, he is
currently working on a novel about reinventing our political and governance
systems. He and his wife Pennie live on Torch Lake in northern lower Michigan.
Dick is convinced that he is the youngest eighty-year old, minus an
esophagus, on the planet.
