S4E403 - Transcript
Listen and subscribe on Spotify or Apple Podcasts.
“Cancer Expert, Cancer Patient: A Doctor Faces the Disease He Knows Best”
Transcript is auto-generated. If there are any errors, please blame the robots.
Cody: Ross Camidge is a medical oncologist practicing and researching lung cancer at the University of Colorado. He grew up in Great Britain but has been practicing here for over twenty years. Ross had a couple of minor discomforts that led him to see his doctor. And very quickly, those discomforts led to a diagnosis of lung cancer — the very disease he treats and studies.
In September 2025, he told the general public about his diagnosis, after treating it for about two and a half years. That's when I read about Ross in an article on the Colorado Public Radio website. CPR put us in touch, and I met Ross for coffee. I learned that what started as what he assumed to be a pulled muscle, and then a slight wheeze in his lung, led to one of the most ironic diagnoses I've ever heard.
But even through treatment, he continues to practice, treat patients, and speak about his new experience of being a patient — with a special perspective. I've enjoyed getting to know Ross and his unique point of view, and I think you will too.
This is Dying to Tell You.
Ross: It's interesting, because you're coming out after you've spent a couple of years getting your own head around it. So it's not quite like dealing with other people's anxiety while I'm dealing with my own — I'd already sorted through my own situation. And the other nice thing was I could say, look, people don't know what to say. Cancer's this big, scary word, but hey — you've actually been interacting with me for the last couple of years, and during that time you were interacting with the cancer patient. Surprise, right? And it wasn't terrible. Presumably our interaction was okay.
Cody: Mm-hmm.
Ross: And I hope one of the reasons for coming out of the closet is to normalize a terminal diagnosis. That sounds very weird when you say it [word unclear], but that's one of the things I'd hope would come out of this.
Cody: Yeah.
Ross: My favorite example of the importance of bringing normality into any conversation with someone with a cancer diagnosis is a friend of mine who was diagnosed with breast cancer. She described how, when she told her friends, they were all kind of sad-eyed and didn't know what to say. Her best friend said, "Well, not to one-up you, but my commute sucked today." And that — that is how to talk to a cancer patient.
Cody: That's good, that's good. Do you hope that people continue to interact with you as they have for the last two and a half years, not knowing that you have cancer?
Ross: I think that's what we'd all like. I think most people — whenever an event happens to them — they're still the same person. You lose a leg, you have some health issue, you want people to treat you as the same person, because otherwise the unfortunate thing kind of wins. It sort of dominates. I don't want to be "the lung cancer in the third bed." I'm still the same person I was. I just hope I can bring a little more insight — not just through my words, but through my example.
Cody: So, a little more than two and a half years ago — what was happening? What were your symptoms that made you think you should go get checked out?
Ross: It was spring of 2022, the end of May. I started to notice a change in my breathing — a noise. Normally you breathe in, then breathe out, but when I breathed out there was a little extra noise at the end, like a little balloon that hadn't quite emptied, and then, "oh, it's my turn" — right at the end. For me, that sounded like there was a structural thing going on in my lung. I really wanted it to be late-onset asthma, but I kind of knew it was something different.
I sat on it for about a week, no more, and scheduled to see my primary care physician, who was away, so I saw a locum instead. I told my wife I was a bit worried about it, and she said it was all going to be fine. I went to see the locum, and he was busy writing a prescription for an inhaler. I said, "You do know what I do for a living — we work in the same building." He kind of rolled his eyes. I said, "Could I have a chest X-ray?" He said sure. So I left his office, went down in the elevator, through the X-ray department, got my X-ray, then wandered up to my office. He phoned me and said there was something on the X-ray and we needed to do a CT scan. I pulled up the X-ray myself in my office, and I went: that's lung cancer.
Cody: Hmm.
Ross: I could tell — that's what I do for a living.
Cody: Right, right.
Ross: There was a mass at the top of my right lung. You could see it just on the chest X-ray, which is a fairly blunt instrument, but I could also see what looked like little dots in the other lung. So I already suspected it had spread to the point where it wasn't curable. I called my wife and said I thought something was going on. She was up at Dillon Lake for the summer with our two daughters, who were about ten and twelve at the time, and some friends. I told her she didn't need to come back — I was going to get a CT scan and would talk to her later.
I went to get the CT scan of my chest that afternoon, and this time I didn't wait for anyone to call me — I pulled the scans up myself. I could see the mass at the top of my right lung, lymph nodes in the middle of my chest, deposits in both lungs, and something eating into the bone, which was probably the cause of that stiff shoulder. And then I clicked into professional mode.
Cody: I'm wondering — when you called your wife to tell her, did you tell her, "I think I have cancer?"
Ross: I actually don't remember. I think I shared my fears and concerns with her. When there's a shadow on a chest X-ray, we all know what that means, at least in the movies. So I think she knew — I just don't know if I said those words out loud at that point.
Cody: So you switched into professional mode. And then what?
Ross: That was a Friday afternoon. On the Saturday or Sunday, I came in and had an MRI scan of my brain — it's pretty common, about 20% of people with lung cancer will have had it spread to their brain by the time they're first diagnosed, and I was no different.
Cody: Hmm.
Ross: I pulled the scan up myself, again in my office, by myself, and there was a two-centimeter mass in my brainstem. Your brainstem isn't much more than two centimeters, so I was looking at it thinking, that's not compatible with life. That's not a good thing.
Cody: Still in professional mode.
Ross: Yeah. That doesn't just suddenly disappear.
Cody: Sure.
Ross: It was like, okay, let's get all the bad news on the table. So I knew absolutely that the cancer had spread. This wasn't something surgery was going to treat, and it wasn't something radiation therapy was going to cure. I was incurable, metastatic, terminal — whatever word you want to use — with the disease I'd spent twenty-odd years looking after.
Cody: The irony. Do you know any other medical oncologists who specialize in lung cancer and have lung cancer themselves?
Ross: No.
Cody: I just can't imagine — what are the odds?
Ross: Ironically, over the years I became the go-to person for physicians around the country who got lung cancer. They'd contact me — some of them were medical oncologists themselves, but general oncologists — and they'd usually do this slightly funny thing where they'd email saying, "Hey, can I chat with you about a patient?" And I'd say, "Sure, tell me about them." And they'd say, "Actually, the patient is me." I'd been through that before — I've had physicians as patients. But I'd never had the irony of someone who's an expert in a particular disease having that particular disease.
Cody: When we were talking before, we talked about this — your professional life, and now you're looking at scans of a patient that just happens to be you. I'm curious how you go from the cerebral "this is not good for this patient" to the emotional response of "this is not good for me." Or did you? I'd think going into professional mode would be a very effective coping mechanism.
Ross: I don't know if you'll believe me, but it's possible to have two separate things going on in your head at the same time.
Cody: Definitely believe that.
Ross: So the professional me was thinking: okay, got the scan, next I need the biopsy. The biopsy was scheduled for Monday. The pathologists needed to run tests on it, which they did Monday night, and I saw the results Tuesday. There was a specific mutation in the cancer — one I must have acquired at some point in my life — that was driving it. Some of what I'd spent twenty-odd years researching involves these specific subtypes of lung cancer that you can sometimes treat with just a pill. This particular mutation is called an EGFR mutation, for anyone who wants to nerd out, and there was a pill for it.
And then the other part of the perfect storm: the husband of one of my patients — she'd passed away no more than about two weeks before — had handed me back her remaining pills, which happened to be the exact pills used to treat this mutation. They were sitting in a cupboard in my office. So Tuesday evening, when the pathologist told me about the mutation, I sent my wife a picture of the pills in my hand and said, "Well, the journey starts today." Four days — from wheeze to diagnosis to treatment.
Cody: Wow. Back to the question —
Ross: Yeah, I avoided it.
Cody: That's the other thing.
Ross: I just went into professional mode. So — your question was, when does the emotional part kick in?
Cody: Or, what was the emotional part like?
Ross: I remember sitting on the stoop of our house — it was summer, my wife and I, with the kids inside. We hadn't told them yet. We were talking through how we were going to tell them, and I think we both started crying. I found that the professional face of me held up pretty well, but there were two things that would punch through it and get straight to the emotional heart of me.
One was any thought of my daughters — you always think about your kids' future, what they're going to turn into, and the sudden realization that I wasn't going to be there for so many things in their future. I didn't know if I had six months, a year, or several years. That would just make me well up.
The other thing — and this is interesting in itself — was just anyone being nice to me. I didn't tell many people, but I told my immediate team, the colleagues who had to be there, who did the biopsies and the analyses. They were very kind, and I didn't know how to deal with that.
Cody: Mm-hmm.
Ross: Those things would just punch through whatever the professional was, and I would well up.
-BREAK-
Ross: We told the girls by the end of the week. My wife had Googled how to break bad news to preteens, and the answer was: you don't present them with a period, you present them with a comma. So we told them, "Daddy has lung cancer, and it's not curable. He's already on treatment. You've met some of his patients at functions and things, and they do pretty well. We're not asking for anything special from you — maybe an extra hug here or there — but your life, because you're pretty self-centered at that age, is going to stay the same."
These pills, which are great at controlling the cancer, aren't a cure.
Cody: Right?
Ross: At some point the cancer evolves. If the pills change the environment, the cancer shrinks up, but it's still alive, and it introduces diversity — additional mutations — and it's like solving a Rubik's Cube that keeps changing: now it can grow in this environment. You do everything you can at the beginning to minimize the cancer's options — you reduce the number of cancer cells as low as you possibly can, so there are only three people solving the Rubik's Cube, not three billion.
Cody: Yeah.
Ross: Toward the end of 2022, while staying on the pill, I had a course of chemotherapy to shrink the cancer further. Then we used radiation — what's called consolidation radiation — to zap pretty much everything that had shown up on the original scan. The scan isn't the eye of God — there's going to be other stuff that's microscopic — but you take what you can see off the table, reduce the diversity in the cancer, and make it harder for that evolution to happen.
Cody: Was it surprising — how was it for you to be receiving all the treatments you'd prescribed for so many years? Was it harder or easier than you thought?
Ross: Two things. First, I was still in the cancer closet at this point — my immediate team knew, but I couldn't go to the chemotherapy infusion center at my own hospital, since I'd run into my own patients. So I went to the one in Cherry Creek, where the only other person I had to tell was the doctor there, who happened to be one of my first trainees. I think he found it harder than I did.
I went in with a kind of childlike wonder — "Wow, this is what it's like."
Cody: This is awesome, huh?
Ross: Or, "wow, this is what a CT scanner sounds like," or, "my goodness, this is the funny taste in your mouth when they give you chemo." People had talked about it, but I'd never experienced it myself, so I really enjoyed — in inverted commas — the chance to truly walk in my patients' shoes.
Cody: You really are a researcher, aren't you?
Ross: Well, there's that, but it's more than that. I spent twenty years looking after a somewhat marginalized community of people with lung cancer, and within about a week I'd rationalized that it was a privilege to be able to walk in their shoes.
Cody: Would you say more about that?
Ross: You've been a chaplain — in old-fashioned terms, you have a flock of people you look after, as the shepherd.
Cody: Mm-hmm.
Ross: And I've championed that for lung cancer for two decades, and I couldn't think of anything more fitting than really understanding my patients at that most personal level — by literally walking in their shoes. Some of the people who found out later would say — apart from the irony — "If anyone should get lung cancer, it shouldn't be you." And I'd correct them: no, I'm no less deserving of this diagnosis than anyone else. If anything, I can deal with it better, because I understand it. So I think that's the privilege — I get to take one diagnosis for the team.
Cody: I've had the privilege of meeting several physicians with a terminal diagnosis — nurses too — and a close friend who's a social worker dealing with cancer right now. I often wonder if that expertise better prepares someone, or if it just gives them a little too much insight into the reality of the situation. What do you think?
Ross: I've seen it both ways. I've looked after doctors, nurses, and other healthcare professionals with a cancer diagnosis. Some of them are like, "I get it, I understand what's coming, and I'm okay with it." I've had some who used medical aid in dying because they wanted to avoid what they thought was the inevitable end. I've had others where it depended on their age and what was going on in their life — they didn't want to treat it at all. And I've had others who were just trying to be the best patient they could be, having seen good and bad patients themselves. The stereotype of the physician as a difficult patient hasn't really held up. The only thing I've seen is occasionally a physician self-diagnosing and self-prescribing for their own symptoms, and getting into a bit of a mess with that.
Cody: Let's get back to the professional side — the treatment. You went through the chemotherapy and radiation, and all your fascination and eye-opening experiences with that. How did that go? I assume it went fairly well.
Ross: It went pretty well. I didn't miss a day of work — I kept my clinic, though I decided not to take on any new patients. I could hide that under the story that we had new faculty who'd come on and needed to build their clinics, and since everyone wants to see me because I'm the big name, closing my clinic to new patients was the decent thing to do. The real reason was I didn't know how long I had, and I didn't want to commit to a relationship with a patient that I might end up backing out of, for want of a better euphemism.
I'd get a little on edge, for want of a better word, right before my scans — I had scans every 90 days, brain and body, to check things were under control. This is where the emotional brain takes over: you start thinking, on this day, at this time, when I get my results, my fate will be decided. Which is somewhat silly, because in your head it's like they're going to open an envelope and you're either alive or dead — but you're obviously not dead, since you went into the scanner alive and came out alive. Your head just doesn't let you imagine the future until you have that result. So for about a week beforehand, I literally couldn't plan anything, even for the week after. And you get grumpy when people ask, "Can you do this? Can we go out to dinner?" And it's like, eh, maybe.
Cody: And you can't tell them why, even —
Ross: Well, the people who knew, knew. And usually you get grumpy with the people you love the most, so they already knew. But yeah, it was a weird kind of headspace. They call it "scanxiety," and it's real. Going through it myself gave me some insight into helping my own patients deal with it — just by calling it out, naming the elephant in the room, the difficulty of not being able to see the future. Their eyes would light up: "Yeah, that's exactly it."
Cody: Were there any other things that changed in how you practiced?
Ross: I joked with you the other day that when people ask me that question, the implication is that I was some terrible doctor before.
Cody: You were bad before, but now —
Ross: Yeah, I was awful. But now, oh, now I get it.
Cody: Now you're compassionate.
Ross: There was a movie called The Doctor, with William Hurt — he plays this complete stinker of a surgeon, and then he gets some kind of cancer they can cure, and he becomes a nice guy. But no — I think I developed more insight into the practicalities, the scans, the anxiety around them. I'd like to think I was already an okay doctor at listening and connecting with people, so if there was a change, I hope it wasn't huge. But I'm sure it made me somewhat better too.
Cody: I didn't mean that you were bad before — I wondered if it gave you more insight into your patients' experience, and if that changed anything you did.
Ross: I think I had more insight into what side effects were really like. I'd been working on something from a research perspective on how we describe side effects, particularly for new cancer treatments. They come from an era of chemotherapy where we describe peak toxicity — at its worst, you're going to be throwing up four times a day, not three, not six, but four. And you ask, "Great — what day will that happen? How long will it last?" And the answer is, I can't tell you. The way we describe it isn't user-friendly. Whereas having gone through it myself, I could actually say, "You're going to be non-functional for this many days, and then you'll be good and can go back to work."
The average time the pill controls the cancer is about 18 months. Mine was controlled for 24, 25 months before something started to show up.
Cody: And then a progression of your disease happened.
Ross: Yeah. One of the other things we've championed — thank you, Dr. [name unclear], for helping develop this — is that we don't just rely on CT scans. We also use some blood-based markers, and if those start to rise while the CT looks normal, we say the CT is missing something, and we do a different kind of scan — a PET scan. That's exactly what happened to me. My CT scans all looked great, but one of these blood markers started to rise, so we did a PET scan, and there was a little patch at the back of my right chest wall, a few inches below my shoulder blade, which is probably what was causing that tightness I'd noticed. That was the first weed growing in the garden, in the presence of the weed killer — the first evolution of the cancer. It's not game over — if you catch it early, you can spot a clone of the cancer growing before it spreads.
That was the beginning of this year, so we jumped in with more radiation to that area. I figured it probably wasn't the only weed, just the only one I could see, so I went back on chemotherapy. There'd been a development — if you wait long enough, research moves around you and you can benefit from it — a new drug had been licensed [drug name unclear] to make the chemotherapy more effective and help people live longer. I discussed it with my oncologist and we added it in.
I had terrible side effects from that — it exaggerated all the chemotherapy side effects. I was very nauseated, very constipated. I hope whoever's listening is prepared for these kinds of discussions.
Cody: I think so.
Ross: The idea that I couldn't get food in at the top and couldn't get anything out the bottom was just incapacitating. I lost 10 to 15% of my body weight. It gave me a rash, which has now turned into freckles, but at the time was inflamed skin — particularly on my scalp, where I actually got sores, some the size of your palm, taking up much of my hair. I buzzed my hair to make it easier, but it still happened, and I went from being somebody with cancer who nobody knew, to somebody who looked like they had cancer. I remember looking at my skinny arms and legs and thinking, I don't know whose body this is.
Cody: Weird sensation. How did you manage to stay hidden during that time?
Ross: I was still doing clinics. I started wearing theater caps — the kind surgeons wear — and a face mask, so they couldn't see the rash. I told people I had a cold and would just wave at them. Maybe they suspected something, but we still managed to keep the secret. For teleconferences and national and international meetings, I dialed in from my office over Zoom — miraculously, my camera wasn't working for a few months. But it got to the point where, between not telling the whole truth and actually misleading people, I described it to someone as, at its worst, like death with vomiting and constipation. It was pretty bad. And I thought — if I'm going to end my life anyway, the idea that I might be able to do some good, because of my platform, by coming out with this diagnosis — this was the time.
Cody: It seems like the side effects from that chemotherapy regimen were — I don't know if "impetus" is the right word, but a catalyst.
Ross: Well — I know that life expectancy shrinks when that occurs. So you go from this theoretical "maybe I'll be the one at the tail end of the curve who doesn't progress" to, nope, you're going to be just like everyone else.
Cody: Was that disappointing?
Ross: No. I'm a fatalist at heart.
-BREAK-
Cody: What would you say your prognosis is now?
Ross: Somewhere between six months and two years, with a lot of unknowns. It depends on when the next progression occurs, whether it's isolated and treatable with radiotherapy, whether I'll go back on some kind of chemotherapy, whether it'll respond, what the specific mechanism of resistance turns out to be, and whether that's treatable. I think another progression is probably happening — I can feel it, and I have scans in two days.
Cody: Thank you for saying that. I think oncologists are often reticent to give a prognosis, and it's instructive that even you, as the expert on your own cancer, can only give a broad range. It's eye-opening to hear that.
Ross: When people ask the "how long have I got, doc" question, which comes up fairly often, the answer — for anyone thinking of going into oncology — is never six months, because if you say that, people fixate on the number and circle it on the calendar. What's more appropriate, both for communication and scientific accuracy, is to describe the units it's measured in.
Cody: Mm-hmm.
Ross: Days, weeks, months, years. And you present the average, but also the range — a best-case and a worst-case scenario. Best case: these things come up as little weeds, we control them, and we're talking a number of years — less than a decade, but years. Worst case: the cancer finds the magic formula to grow and takes off, and you're talking months.
Cody: Up to this point I haven't heard you talk about whether or not to treat — it's been assumed you'd do the treatments as they come. After we talked last night about your most recent chemo and how difficult that was, can you imagine a time when you'd say there might be more treatments that could work, but they're not for you?
Ross: I've already been there. I was supposed to have four doses of that new drug, and I got to three and said, I'm crying uncle, I can't do this — because the treatment was worse than the disease.
Cody: If you have your next progression, do you know what the next treatment options would be? If anyone would know, it'd be you.
Ross: It's funny — that was a bit of a mental no-go area for me for a while, and then just last week I thought, put your big-boy pants on and think it through. If this, then this; if this, then this. I think if the progression is localized, it'll be local radiation. If it's more widespread, probably a biopsy to see what's going on and whether we can tweak the pills. If it's none of that, it starts to get a little darker — different chemotherapy, without that other drug added in. And you start to see death as less of a theoretical possibility in the distance — with a cancer diagnosis, you get to wave at it from far off, and then suddenly it's right under your nose.
Cody: Last night you described it as — we're all driving down a road headed toward a bridge that's out, and you have your headlights on, while everyone else is driving in the dark.
Ross: Yeah. They all know it's going to happen at some point, they just don't know when. I can see it, and as I get closer, it'll become clearer how long it'll take me to get there.
Cody: As you get closer, what's become more important to you?
Ross: One thing is the people you touch. My daughters are at the top of that list — what I can do now to prepare them, emotionally, financially, all of it. Then there's a realm around that — close family — and around that, the professional people I've mentored, some of whom I've been a kind of second father figure to. Making sure they're okay matters. The career itself doesn't really matter to me — it hasn't for a few years. I don't care about another prize, another lecture, another publication. Seeing other people's success that I've helped along the way means much more to me.
My medical school just had its 30-year reunion, and it's funny — this group of people I knew as medical students, who were mostly goofing off, you meet them now and they've either retired or are contemplating it. It's like, "So what did you do in the intervening 30 years?" "Oh, that was when you worked." "So how did that go?" And it's just a page in a book.
Cody: It's hard not to see your life as all wrapped up in that working space.
Ross: Yeah. Who you are is your job. And yet once you get past it, it's just a chapter in a book.
Cody: So apart from your job, who are you?
Ross: One thing — I want to thank you for calling me by my first name and not "Doctor so-and-so," because I wasn't born a doctor, and I'm not going to die a doctor. I'm not going to die with my stethoscope on. That was a period of time, and I get some enjoyment thinking I made the world a somewhat better place — for my patients, or for a bigger community through some of the research. But at the end of the day, the people who really matter are the people you've touched in loving relationships, not professional ones. Those are the ones you treasure, and you hope you didn't screw it up too much.
Cody: Indeed. The theme I hear from people is just that — the things, the house, even the experiences pale in comparison to the relationships. It's a common theme.
Ross: I like the story you told me — that people don't have a bucket list of grand trips. They just want to sit and cook dinner with their family.
Cody: Yeah, that's what I want to do now, and also when it's my turn to come to the end. I was on another podcast once, and they asked what I want at the end of my life. I said, I just want to lie on my couch and listen to people cooking in my kitchen. That's all I want.
Ross: One of the patients I looked after early on — we'd had the conversation that there was nothing more we could do. Her husband wrote to me after she passed; they'd had a few months in hospice, and she worked through her favorite recipe book, cooking every recipe in it. He said those were the most valuable two months of their entire relationship.
Cody: Yeah. And as far as anything monetary, or big events — unremarkable, right? Just completely ordinary, being at home, cooking with each other. That's beautiful.
Ross: My favorite example: my wife spent a while binge-watching The Bachelor and The Bachelorette. The reality is, you don't build a relationship on the deck of an ocean liner with an orchestra playing while you have dinner. The reality is more like going to Target and walking down the aisle.
Cody: Yeah. What are things you want to make sure you do before you die?
Ross: We're always going to leave things unfinished — that email inbox is never going to be emptied. I don't have to be buried; just cover me in emails. I've written two books, both of which I started before my diagnosis, and I'd love to find an agent to get them published — the people who've read them seem to like them. I want to make sure my youngest daughter, who's applying to high school, gets into a good school, and I want to do whatever I can to help my oldest daughter prepare for the real world. Financially, we're okay, which is a blessing. Not a huge number of other things — I try to have some new experiences during this time, to keep things fresh. The last thing you want to do is just sit there and give up.
I created something called the 90 Day Challenge, which I shared with my patients — you've got 90 days between scans, so don't just sit there and wait for bad news. Come back and tell me, almost like a prescription, what you did in those 90 days. You don't have to climb Mount Everest or become a violin virtuoso — if you want to take one violin lesson, that's fine. If there's a restaurant you've always wanted to try, or someone you haven't called in years, just do something, so you can say, in those 90 days, I did this. Maybe it was all in one afternoon, but you did something.
I've tried to live that message myself, and it's been fun — people have helped me with it. I took my first knitting class a couple of weeks ago.
Cody: Very nice.
Ross: It's strangely therapeutic. Once you come out of that closet and say, "I'm a man and I knit," there's a support community you'd never imagine — though then people start giving you orders, "a scarf, please." I'm just learning the basics — maybe a washcloth is about as far as I'll get.
Cody: Like a trivet or something.
-BREAK-
Cody: How do you feel?
Ross: You mean, physically?
Cody: Whatever you want to answer.
Ross: Physically, I'm slightly stiff in the right posterior — the back part of my rib cage, which I think is where something's going on. Otherwise, physically I'm not too bad. I still make a funny wheezing noise at night, but that's not a deal-breaker. Mentally, I think I'm okay — I've got my head around it, and being given the opportunity to do some good in a different way, by speaking publicly, is a gift to me. Emotionally, most of the time I'm okay. I just went on vacation with my two daughters, alone, to visit my brother in Germany, and I joked with my wife afterward that I have a new respect for how she looks after the kids full-time. How do you even think about anything else? I was the be-all and end-all — getting them up in the morning, breakfast, all the things teenagers don't want to do. That was good. That was precious for me.
Cody: As you think about the next six months to a year or two, when you'll come to the end of your life — how do you want it to be? Do you have thoughts about that?
Ross: One small aside — I often explain to physicians in training, other healthcare professionals, and sometimes even patients, that death isn't a failure, because otherwise everyone's life is a failure.
Cody: That's right.
Ross: That said, there are good deaths and bad deaths, and mostly that relates to how long the period of disability is, and whether you have your mental faculties during that time. In an ideal world, my brain is still functioning and it's just the body's life-support system that fails.
Somebody asked me the other day whether I'd ever consider medical aid in dying — that's a whole other discussion, but I have prescribed it several times myself. I can see it — when I was in the basement, so to speak, with death by vomiting and constipation, I had zero quality of life, and I could see that being the last act of self-control. But the same way I've seen with patients I've helped through medical aid in dying — sometimes the disease doesn't care what your plans are, it just does something, or something sudden happens. So yes, in an ideal world — not that anyone's listening — it would be: maintain my faculties with minimal loss of function and independence, and a fairly swift end. Not so swift that I go out and don't come back, but a short number of days.
Cody: You said "not that anybody's listening" — are you a religious person?
Ross: Well, chaplain…No. I grew up with school assemblies, church messages, and I think I have some spirituality — I have discussions with somebody — but I don't really buy into organized religion. It just doesn't work for me. I respect it in other people. I wish I did have that; I think it would be a great comfort. But no — I suspect when you're gone, you're gone.
Cody: Is that distressing, or comforting? Either one.
Ross: That's like asking if gravity is distressing or comforting. It just is.
Cody: Yeah, I don't know. Sometimes I wish I could fly.
Ross: Wish you didn't drop things on your foot, right?
Cody: Sometimes it is distressing. People ask me, fairly rarely actually, what I think happens at the end — and it depends on the day.
Ross: Well, what do you think happens?
Cody: I don't know — and I think that's the only honest answer, as far as I'm concerned. Today, sitting here with you, I think you're probably right. We have this electrical firing in our brain, and it stops, and then not much happens. There's an energy in us that doesn't go anywhere — it dissipates, goes back into things — but I don't think I'm going to wake up on the other side and have myself, my memories intact, and be me.
On the other hand, I have some hope that I get to do this again — it's been so much fun. I'd love to think there's this infinite wheel of life, and I could come back and experience it again, though the likelihood that I'd have the wherewithal to recognize that, I don't know. So I have those hopes, but probably, probably it's just over and out. Right now, that's not distressing or comforting — it's an invitation to put as much as I possibly can into what I'm doing right now.
Ross: There's something you can do with your body afterward that I'm intrigued by, that helps with that. I have a garden, and I really like my garden — if you're cremated, the ashes are quite alkaline, which is basically poison to your garden. So scattering ashes isn't great for plants. But there's this thing called body composting — it's not legal in Colorado yet, but it's legal in several states. They put you in an incubator with some enzymes and straw, and turn you into about a cubic yard of soil.
Cody: Yeah.
Ross: Most of it gets donated to national parks, but you can keep some containers of the soil. I love the idea of my kids throwing it in the garden, growing some plants, and pointing at a sunflower saying, "That's a bit of Dad in there." The company is called Earth — you can look up "Earth funeral" — and it's already legal in a few places, including where a friend of mine lives. We decided to become death buddies and signed up as founding members.
Cody: Okay.
Ross: So once it's legal in Colorado, I get a discount.
Cody: Could you be transported somewhere it's already legal?
Ross: Yeah — apparently you can. You just have to make sure whoever's in charge of your body is on board with it. There's a whole element of, yeah, it'd be nice to do this, but I'm not going to be around to care.
Cody: That's true. But especially for your daughters, it might be meaningful.
Ross: Yeah, I mean I said to my death-buddy friend, it'd be really cool if this took off, and then when you went to the flower shop and bought flowers, instead of it saying, you know, chrysanthemum, it said, "this is Joe Schmoe" — those flowers have a story.
Cody: Really?
Ross: I'll have a bunch of Ross, please.
-BREAK-
Cody: All right — the last question we ask everybody: how do you want to be remembered?
Ross: I'd like to be remembered as the best guest you ever had on this podcast.
Cody: Well, yeah — I think you're doing pretty well.
Ross: But seriously — when you told me you were going to ask that question, the answer is actually another question: it depends on who. How my kids remember me could and should be very different from how a casual acquaintance remembers me, or somebody who just knows me by reputation. You get into these nested circles. At the center are my two daughters. It's hard, because I know I'm going to leave them before they're fully independent, and they may well feel that I've abandoned them. I hope at some point they realize that's not by choice — that given the constraints of the time I have, and the emotional and mental energy available, we just try to do the best we can. I hope they remember the good times, the times we laughed, the times we cried — that we were together, as a unit.
Then, as you expand outward, to people whose lives you've touched in some way, but not quite as intimately — you want to think you impacted them positively, that you were a role model, or maybe even an example of what not to do, but that you made them feel seen and valued, and that they get to continue the great experiment of life, and hopefully do bigger and better things. And for the people who don't really know me, but see me as a leader in some field, they can decide whatever that means to them.
Cody: I think you're the first person to really parse out the concentric circles of influence, and I really appreciate that. Well, thank you so much — thank you for your time, for coming here, and for being so generous with your thoughts and your experience. Appreciate it.
Cody: Thank you, Ross, for sharing your story and offering your perspective as a physician and a patient. I hope to follow up with him in the coming months for a callback. When we do, you'll be able to find that episode at patreon.com/dyingtotellyou, where you can subscribe for free to get access to videos from our interviews and other content not found anywhere else.
Thank you for listening. This is Dying to Tell You.
