By Grant Pick
A doctor announces that the cancer has spread or your heart is hopelessly weak. You lose weight and energy, often encounter intense pain. With weeks to go your breath becomes short and you take to your bed, restless, disoriented, your body temperature spiking. Excessive sleep or a coma follows and then you're consigned to history.
We seldom contemplate this trip in advance, preferring to think we'll somehow evade it. Even doctors blind their eyes to this dark territory. Roger Conley Bone, a famed pulmonary physician, recently died of cancer at age 56. He'd studied death at close quarters throughout his medical career, but only as he stood close to his own did he finally fathom it.
"Dying is very hard, the hardest thing in life," said Bone in May, a wasting figure lying on what he anticipated would be his deathbed in a lakefront high-rise. "It's certainly the hardest thing that's ever happened to me. I have pain. I can't do bodily functions. Tumors are all over my body. If I walk, I worry that I might slip my hip out of joint and never be able to walk again." But Bone insisted on making his last days as productive as possible. "I could stay in this bedroom and scream, but that doesn't seem a very constructive way to spend one's final days," he said. "And this can be a tolerable, even a good time."
A generation has passed since the hospice movement surfaced in the United States and Elisabeth Kubler-Ross did her pioneering work on the psychic process of dying. Perhaps our society is finally coming to terms with death. As the baby boomers age, discussion has increased--about the needless prolonging of life through technology, doctors' improved ability to relieve pain, and the dignified deaths of public figures such as Jacqueline Onassis and Joseph Cardinal Bernardin.
"We can now take dying as the culminating experience of life, rather than the abject, dejected, and solitary farewell that we all fear," says Dr. Linda Emanuel, vice president of ethics standards for the American Medical Association. "If we use technology, we can maximize the quality of the life that people have left, as they accept the inevitability of death. Dying is a very personal matter, but the more we understand how others die the more fulfilling we can make the experience once we get there. And in reaching that understanding someone like Dr. Bone was fabulous."
Roger Bone grew up in Bald Knob, Arkansas, a hamlet set in strawberry and cotton fields 60 miles northeast of Little Rock. His father Conley operated one of three grocery stores in town, and his mother ran a beauty shop out of the house. "Dad was very old-fashioned," remembers Roger's younger brother Larry. "He himself had grown up under difficult circumstances, and all he could remember were the hard times. During the summer he worked Roger and me six days at 35 cents an hour. By the time we finished scrubbing the floor on Saturday night it would be 9:30 or 10 o'clock, and we'd be awfully tired."
The punishing routine fired the ambitions of both boys. "One of my drives was that I didn't want to live my life in Bald Knob," Roger related. "I wanted to be a doctor, though back then Little Rock was as far as I could see." The brothers matriculated at Hendrix College, the state's most prestigious private college, and went on to the University of Arkansas medical school. At Arkansas, recalls Larry, "Roger was always going beyond. I'd be reading a textbook on gross anatomy, and I'd stop to see my brother and he'd be studying three or four textbooks." In 1965, with his sons still in medical school, Conley Bone died of a heart attack at age 46. "He worked himself to death," says Roger, "and I inherited the work ethic."
As a decorated army captain and field physician in Vietnam, Bone came up square against the horrors of war. "In Vietnam MASH units there were no clean shots," he said. "You'd always see triple amputees--two legs and one arm gone, or one arm and two legs. It was pure mutilation. I learned that I hated war, but I also learned about medicine." It was in Vietnam that he became fascinated with septic shock, the potentially fatal outgrowth of sepsis, the release of bacteria into the bloodstream.
Back in the U.S., Bone took his internship, residency, and a fellowship in pulmonary and critical-care medicine at the University of Texas Southwestern medical school at Dallas. Beginning in 1972, he taught and practiced at the University of Kansas Medical Center in Kansas City. Then in 1979, not yet 40 years old, he was named chief of pulmonary and critical care at the University of Arkansas Medical Center in Little Rock. He directed research into septic shock, a prime cause of death in intensive-care units. He penned a slew of septic-shock articles, though he also wrote pieces on other topics and edited authoritative textbooks, most notably Pulmonary and Critical Care Medicine, published in 1993 and updated annually since. "He was a philosopher, a synthesizer," says one longtime colleague. "He didn't do the original research--he wasn't going to be the one to win the Nobel Prize--but he put the hows and whys together." Bone's most significant contribution was probing the pathology and treatment of adult respiratory disease syndrome, a septic-shock-related shutdown of the lungs that had dramatically confronted physicians on the battlefields of Korea and Vietnam.
In 1984 Bone arrived in Chicago as chairman of internal medicine at Rush-Presbyterian-Saint Luke's Medical Center, supervising 15 specialties. He also served as the pulmonary and critical-care chief, and for a period as the dean of the medical college. At six foot two, Bone was a towering presence, with a pleasant yet formal demeanor and a near photographic memory. He made the most of his opportunities, powered by an almost otherworldly drive that mimicked his father's. "I worked 14- to 16-hour days because work for me was play," he said, "and I did that more at Rush than anyplace because I had the power base and the resources to develop what I wanted." He oversaw research, lectured widely, directed training, and recruited top doctors.
"Roger's leadership qualities convinced you to share his vision," says Dr. Leo Henikoff, president of Rush. "He was a workaholic, yes. Sometimes that means a person is only into process, but Roger got things done--he was into outcomes. He accomplished more with time than anyone I know." Stuart Levin, an infectious-disease specialist, doubled as Bone's second-in-command of internal medicine. He recalls meetings that one or the other would walk out of on the grounds they both weren't needed there to get the job done; these departures tended to focus the attention of everyone left at the table. "We forced more decisions than you could imagine by walking out to the bathroom to urinate."
Though Bone was often perceived as exceedingly businesslike, he could also be exceedingly encouraging. He was known for the careful way he went over student papers and for the way he dealt with residents. "When Roger talked to you, you felt that here was this person of great accomplishment trying to help you," says Michael Davidson, a former resident who's now president of the Chicago Center for Clinical Research. Says Robert Balk, who trained with Bone in Little Rock and is now Rush's director of pulmonary medicine, "He invigorated you to reach your potential. He was the epitome of a leader."
"With my patients I was a good, compassionate physician," Bone said of himself. "But to a limit. We would make grand rounds, and there I was, the chief doctor, the leader of the team, like [fabled Texas heart surgeon] Michael DeBakey. DeBakey might know each chest--and the physical problems it posed--but he wouldn't necessarily know each person, and so it was with me. I'd lay out a patient's treatment plan for the day and then leave the particulars to my interns and residents."
Bone insisted on his devotion to his wife (and high school sweetheart) Rosemary and to their daughters Mary Katherine and Cynthia. Despite his schedule, he usually managed to return home to Oak Park each night for dinner, and he relished twilight jogs with Mary Katherine. Rumbling along, he exhibited a goofy sense of humor, yelling "hello girls" to preadolescent boys who responded by swearing at him.
But the outside world invariably intruded. When he got on his Exercycle in the basement he tuned in a half-dozen TV sets, muting some while raising the volume on others. "After dinner he would sit down, either in the basement or up in the attic, and out would come a huge stack of paper," remembers Mary Katherine. "He would go through the documents, and if I wanted help with my math homework I had to be firm. 'I need you now,' I'd say, and then he was there for me."
While he relished being out in the backyard in his T-shirt and shorts (an adequate backyard was a necessity of any house the Bones owned), he didn't shoot the breeze much with the neighbors. He wasn't involved in his community, and beyond jogging he didn't have hobbies to speak of, though he listened to self-improvement tapes on art and music. Raised as a Methodist, and once a state officer in a denominational youth organization, Bone let the church go as an adult. "It was predominantly Rosemary and the girls who went to church," he said. Socializing for Roger and Rosemary, a nurse who later became a part-time travel and real estate agent, centered on Rush; at parties he did small talk poorly, preferring to discuss medicine. His friendships tended to involve a few colleagues at Rush, notably Levin and Eubanks, and professionals he bumped into at medical gatherings. "I knew Roger for 25 years," recounts Tom Petty, a Denver pulmonary physician who has taught part-time at Rush. "At meetings or conferences he and I would sit down, laugh, and talk. But he was a hard guy to know."
In 1993 Bone, frustrated with cost cutting at Rush, responded to an offer to become president of Toledo's Medical College of Ohio. "It was a step up, and I was glad for Roger," says Henikoff. He and Rosemary settled into a brick colonial house on a bluff over the Maumee River. At 52, he had a satisfying marriage, two grown, productive daughters, a salary of nearly $400,000, and a national reputation.
That Christmas Day he fell while unpacking books, and blood turned up in his urine. Days later, during a long meeting on campus, he experienced riveting back pain, and when he went to the bathroom his discharge now consisted only of blood and blood clots. An exam revealed a cancerous tumor the size of an orange in his right kidney. A surgeon removed the kidney and an adjoining adrenal gland, and Bone felt the problem had been solved. "I went back to work within a week," he says. "I thought to myself, I'm cured. I had hoped the tumor had been totally resected. The initial scans were negative. You might as well be an optimist."
But in October 1995 a routine chest X-ray showed that the cancer had metastasized to his lungs, which were now filled with two dozen small tumors. Bone read the X-ray and realized, at least intellectually, what his prospects were. "With renal cell cancer the survival rate is only 1 percent."
Bone returned to the house on the bluff. It was 4 PM on a warm Friday. He took off his coat and tie, sat in a lawn chair, and shared the news with Rosemary. "She was devastated, and she was also in disbelief," he recalled. "I had seen hundreds of people with my disease and I knew the prognosis, but I wasn't about to burst her bubble. As for me, I don't recollect denial. I knew it was happening, so why deny it? I'd seen too much sickness in others to pretend it couldn't happen to me. There wasn't anger, either--I had had 54 good years, with excellent health. But there was sorrow, definitely."
Rosemary handed him a glass of lemonade. "Suddenly the lemonade became the point," Bone said. "I tasted the sweetness of the drink, and though I felt my life passing before me I tried to savor the moment."
The emotional process of dying is a pathway charted by Kubler-Ross in the late 1960s. For four years the Swiss-trained Kubler-Ross interviewed terminally ill patients at the University of Chicago's Billings Hospital. Her On Death and Dying, published in 1969, defined dying's five stages: denial and isolation; rage, envy, and resentment; bargaining, largely with one's Maker; depression; and finally acceptance, albeit tired and unfeeling. Though Kubler-Ross wrote that the stages "will last for different periods of time and will replace each other or exist at times side by side," the general impression remains that the phases are to be passed through in sequence.
Many of today's experts on dying prefer to think of dying as a period to be profited from. Charles Corr, a professor of philosophy at Southern Illinois University at Edwardsville and a longtime hospice volunteer, hates the theory of stages. "They make it sound like you're being pulled along through a car wash, and at the end you'll be clean," he says. Corr says many of the terminally ill take on tasks. "For some it involves dealing with pain and nausea. For others it may mean being with someone they love or restoring an old hurt. This is all about maximizing the quality of life you have left." Corr likes to repeat an end-of-life maxim he attributes to a hospice patient in England: "I only hope to be able to say to the people who are important to me, 'Thank you, I'm sorry, I love you, good-bye.'"
Experts also say that people remain who they were as they die; seldom does a scrooge become a saint. "Basically we die the way we live," says Martha Twaddle, medical director of the Hospice of the North Shore. "You can't, in the good ol' American tradition, pull an all-nighter. The essence of who you are remains and, if anything, becomes more vivid. If you have lived like a son of a bitch you'll die like a son of a bitch."
From the outset Bone confronted his dying as an experience to put to use. He'd already written articles for the Journal of the American Medical Association (JAMA), where he'd served as a consulting editor. After he was diagnosed with kidney cancer, but before he learned it would kill him, he sent the magazine an article of a different sort.
In it he offered four cautionary observations: "1. Good health is often taken for granted; however, it is the most precious commodity one possesses. 2. One's spouse, children, family, and friends are the essential ingredients that allow one to endure an experience such as a serious and unexpected illness. 3. When faced with death, one recognizes the importance of God and one's relationship to God. 4. The things one does throughout one's life that seem so urgent are, most of the time, not so important." At a convocation at the Medical College of Ohio, Bone had told incoming students to temper their devotion to doctoring. Now, in JAMA, he reprised that advice. "I would suggest to the students in my speech that they must find the time to balance the scientific with the humanistic. To find not only the time but also the energy to be with family and friends and to enjoy the arts or a good novel or a fine dinner."
After realizing he was dying, Bone wrote three more essays for JAMA. "In my experience it's very unusual for a physician to write eloquently for a public audience about how they feel," says JAMA editor George Lundberg. "Roger, you know, has written hundreds of articles of a scientific nature, but here he was poignant, pointed, and in many ways disturbing."
"I saw death more times than I can count," Bone said in his final essay, which appeared last December. "I always thought that death caused a collapse of the dying person inward upon himself. The dying person appeared to be little more than a shrunken shell lying in a hospital bed. Physical collapse meant that there was a collapse of mental and spiritual being as well. I know now I could not have been more wrong.
"Death has opened my eyes to life--literally. Since learning that I have a terminal illness, I believe my mind has expanded and its appetite has become insatiable. I want to know and experience everything. I feel at times what Thomas Wolfe described when he first walked into the New York Public Library: I want to grasp everything, read every book, listen to every piece of music. I believe that I will walk toward death with that same quest to know."
Bone was now reading Thoreau and contemplating the broad Maumee River--"his Walden Pond," says his brother Larry--that flowed below his house outside Toledo. In his last JAMA essay he described the view at sunset. "I watched the buzzard hawks and a pair of ducks," he wrote. "A woodpecker hammers away at a tree on the other side of the river, taking advantage of the last light to pick a last juicy grub out of the bark. A fish flops somewhere in the black water--probably one of the large carp that school in the shallows."
He dived into John Updike's Rabbit novels and read Our Town, Thornton Wilder's rumination on mortality, enjoying the high school classic anew. The Bone stereo system pumped out Mozart, Beethoven, Vivaldi. "I sat on our patio in Toledo and listened to The Four Seasons and read," he said. "Did all this have something to teach me about life or about death and dying?" If he came to no certain answer, "at least I could savor what was beautiful."
Though Bone said his cancer didn't send him down the path of Kubler-Ross, his colleagues say the normal emotions did emerge--he was no superman. When his cancer reappeared "he was disappointed, shocked, and angry," recalls David Eubanks, director of education at the Northbrook-based American College of Chest Physicians. "He was mad that the cancer had gone the way it had, and he wondered about the initial diagnosis." Specifically, he thought that chemotherapy could have been started earlier. When Bone informed his friend Tom Petty about the metastasis, resentment was mixed with trepidation about the forthcoming chemotherapy.
Throughout his ordeal, Bone said frankly, he sorrowed. "I've been sad, yes," he said, "because I'd like more time with my wife and family, because I'm dying in my mid-50s. Rosemary and I will cry occasionally, over not being able to spend our lives together, over not continuing on." Gallows humor was beyond him. "I don't find humor in anything that's happened to me," he said.
The Bones moved back to Chicago in April 1996, renting an apartment with sweeping views of the lakefront. Rosemary filled the apartment with traditional furniture, Oriental rugs, crystal, and family photographs; her husband assumed a distinguished professorship at Rush. His office was next to the dean's office, and he had no regular duties. But he sounded off, advocating in JAMA, for instance, an FDA-imposed moratorium on a risky critical-care technique of catheterization to monitor vascular pressure within the heart. He continued a course of radiation and advanced chemotherapy--interleukin-2, gamma and alpha interferon, and floxuridine--that caused hair loss, nausea, and the weakening of his bones. Much as he valued the efforts of his oncologist, Dr. Robert Kilbourn ("Bob pulled out all the stops for me"), the cancer remained.
He became even more outspoken in his views. "Maybe through what I say people can come to a greater appreciation of this part of life," he said when I first visited him last April. "Not to be morbid, but there are things to do in advance, things to consider." He was lying under a blanket in a four-poster bed, the curtains drawn against the light. A lamp with a burgundy shade cast an eerie glow. A small fan on the nightstand cooled the doctor; a wheelchair stood in a corner. By now there were tumors in Bone's right hand, in his right shoulder, and in his lungs: fluid on his lungs had to be drained periodically by a nurse.
Over the last decade or so drugs pioneered in hospices have begun to relieve the awful pain that can attend one's last days. A morphine pill lasts from 8 to 12 hours; an intravenous pump provides extra bursts of liquid morphine when needed; a fentanyl patch offers a narcotic analgesic. "Now your every waking moment needn't be in constant agony," says Steven Rothschild, a family physician at Illinois Masonic Medical Center. "Eighty to 90 percent of the time we can give people a constant floor of pain relief." Morphine relieved some--certainly not all--of Bone's pain.
Each time I came to see him, he extended his left hand. When asked how he occupied his days, Bone said, "I can sit in the other room. I watch television and talk to my wife. The reading is much less now, since it's hard to concentrate. Sometimes I look out the window and see people jogging, like I used to do. Now that my body is racked with pain I realize that vitality is such a precious gift."
As Bone's physical world narrowed, his love of family deepened. "You ask yourself, 'Who am I going to miss?' It's not the hundreds of people you see occasionally. It's my younger daughter [Cindy] in medical school, and Mary Katherine, my daughter who's now an administrator at Rush. It's Rosemary. My own father wasn't very expressive to me or my brother, never telling us he loved us--and given who he was I don't blame him. But I have made it a point to always let them know that I loved them and was there for them, and that tendency is all the stronger now. I tell my children and my family hundreds of times that I love them. This is the time to make such statements."
Mary Katherine told me afterward, "I don't feel he left anything unsaid."
Bone took care of final matters--nailing down his finances (enough money for Rosemary to survive on and enough for Cynthia to finish medical school), figuring out his burial site (in the family plot outside Little Rock), and insisting that no measures be employed to keep him alive beyond reason. Bone wanted to die in bed near Rosemary in their apartment, if need be assisted by a hospice affiliated with Rush. (Hospices, of which there are 103 in Illinois, marshal social workers, nurses, inhalation therapists, and chaplains to provide the dying with palliative care at home.
Bone said he was thinking more about God and eternal life. Not everyone is like Cardinal Bernardin, who referred to death as "my friend" and believed he was moving "from one state of existence to another"--in the words of his oncologist, Ellen Gaynor. "Still, for many of us there's a new focus on a belief in something greater out there," says Larry Burton, the head chaplain at Rush-Presbyterian-Saint Luke's. "Sometimes it's mere questioning--why is God doing this to me? And other times there comes a new unity with God. Nonbelievers may embrace Christianity or the Muslim religion."
Bone read the Bible diligently. In April, his eyesight failing, he was watching videotapes of the Holy Land lent from his brother Larry and of a rambling late-night Arkansas preacher he'd recorded off cable television. He also listened to an audiotape Burton had given him of a Franciscan priest and spiritual guide named Richard Rohr. He wanted to discuss what he'd read and heard; one afternoon he talked about how Leviticus anticipates modern-day germ theory. He'd been gripped by a book that dealt with biblical prophesies and Christ's second coming. Burton comforted him with metaphor by inviting him to think of his dying as a sabbath: after his labors he could rest and reflect on the fruits of his creation. Bone said he'd made peace with himself. "I have my own personal confessions that I have made with my God--and will make. I haven't been perfect, nor has anyone."
Much of the satisfaction in Bone's life had revolved around his career, and to a large extent it still did. As I was leaving after our first conversation he handed me his curriculum vitae, a document running to 83 pages that noted the books he'd edited or coedited, some 1,108 articles, and his mentions in Who's Who in America, The Best Doctors in America, and Town & Country magazine. Every outside lecture, prize, and committee chairmanship earned an entry.
When he'd written in JAMA that the urgent becomes unimportant in the face of death, was he denigrating the accomplishments so carefully detailed in the resume? I asked him this the next time we met.
"I spent a lot of time in my career worrying about administrative duties, hiring and firing, fellowships, and research projects," he replied. "All those things were priority items, but I now see that my worrying didn't make success in these ventures any more likely. I should have spent more time with my family and had a closer relationship with my God. I may not have been as successful if I'd written 100 fewer articles. My pride in all the articles I wrote remains. But when my moment actually comes I won't be thinking about them. I'll be thinking about my family, God, and my place in eternity."
The final journey of Roger Bone came as mainstream medicine was rethinking its approach to the terminally ill. Ten years ago the New Jersey-based Robert Wood Johnson Foundation, whose focus is health and health care, undertook a $28 million study of 10,000 critically ill patients at eight U.S. medical centers. Its conclusions, published in JAMA in November 1995, found that doctors often ignore the wishes of patients. As a result, half the patients studied spent eight or more days either comatose or being mechanically ventilated in an intensive-care unit. Half the patients were in moderate to severe pain the last three days of their lives.
Startled by the findings, the Johnson Foundation has launched the Last Acts Campaign, with task forces at work in such areas as doctor and nurse education and palliative care. The American Medical Association is using a Johnson Foundation grant to make physicians and medical students more aware of palliation and acquaint them--and patients--with living wills or at least with a short form some patients are given to fill out stating how they want doctors to handle resuscitation, major surgery, mechanical breathing, and pain. "Yes, we're slow and we're behind," admits Linda Emanuel, who's directing this AMA initiative, "but a generation is relatively short in the history of medicine to come up with a proper intervention." On June 27 the U.S. Supreme Court rejected the notion of a constitutional right to doctor-assisted suicide; the decision, dashing the hopes of supporters of Michigan physician Jack Kevorkian, heightened attention on palliative care.
A paladin of the machinery-filled intensive-care unit, Bone was the kind of doctor the Johnson Foundation labeled as cavalier with patients. "You become shell-shocked to the dying around you," he conceded. "Doctors want to cure, to think that for every diagnosis there is a prescription to make things better. But what do you do when the cure is a failure? You may walk away. Doctors need a way to deal with failure. They need to tell their patients, 'We still love you though we can't cure you, and we are not rejecting you as a patient."
Last October Bone was invited to deliver the convocation at the annual meeting at the American College of Chest Physicians in San Francisco. As a past president of the group and one of nine masters among the college's 15,000 members--a practitioner judged to be greatly gifted--Bone would have been welcomed in any case. As he was dying he drew an especially big crowd at the Moscone Convention Center. Bone wasn't sure he'd be fit enough to speak, so he had taped his remarks.
Dressed in a red tie, white shirt, and dark suit, the doctor looked gauntly into the camera. "I spent my life thinking about medicine. Medicine was everything to me, as it is everything to you." But he told his fellow doctors this: "Take time to be with family and friends. Take time to reflect on nature. Take time to contemplate the fullness of life and to acknowledge death as a natural consequence."
Bone drew a portrait of Harry "Rabbit" Angstrom, the car salesman protagonist of the Updike novels, perishing in an intensive-care unit--white-skinned, downcast, tubes running out of his body. Angstrom's wife, upon seeing him, nearly vomited in "a crushing wave of sorrow," said Bone, and continued, "Harry's life was absorbed with the need for something more. Thus, the greatest tragedy in Harry's death was the missed opportunity for a personally fulfilled life. What I hope is that Harry's life is not typical of most of us. Definitely, I would want Harry's life not to be like your life ...
"I cannot sit idly by very long," he said. "We must discuss life and death with our patients more. I have been a medical school dean, the chief of a pulmonary section, and we really don't teach the dying process well at all. We are so involved with the scientific that we unconsciously ignore the dying part of life. My first challenge to you is essentially this--you should try to live as if it is your last day. Now you shouldn't live morbidly, but you should live to appreciate the great things that are out there for us. It took a great event like cancer to make me realize that. My other challenge to you is this--you need to look at your patients who are terminally ill and try to help them find the peace that they may be able to find before they die."
"The speech was a barn burner," says Tom Petty. Bone's peers gave him a standing ovation. Later, at a smaller gathering, he unveiled a new theory on how the immune system may be counterproductive in combating sepsis.
Bone became more attentive to patients, less the superior authority than the equal. When he went to Rush to receive radiation, he would approach others waiting for treatment. "I'm a distinguished professor with terminal cancer," he would say, "and I would be happy to share thoughts with you." He said he had many mutually beneficial conversations.
Bone never abandoned hope. "Early on there was hope that my cancer had been resected successfully," he said. "Then I had hope--slim, yes--that radiation and chemotherapy would take care of it." A year ago, with luck running out, Bone traveled to the University of Arkansas to attempt a new technique in which tiny plastic particles would be injected into the arteries leading to the tumors in his lungs to cut off the blood supply. "If this works, you can write it up," Bone told his doctors in Arkansas. "If it kills me, you'll know you shouldn't do it again." After trying the technique, Bone spent three days in a hotel room in the grip of a high fever; the tumors' growth merely paused. "Now there is hope that there will be some last-minute advance, just like an AIDS patient prays for a breakthrough," he said in May. Rosemary flew to Prague this year for an alternative drug, and though Bone doubted its efficacy he tried it; he also took an experimental drug provided by the National Institutes of Health.
Bone returned to Arkansas to receive awards from the University of Arkansas medical school, from Hendrix College, and from the citizenry of Bald Knob. The town proclaimed March 21 as Roger Bone Day. When Rosemary drove the native son up from Little Rock, he saw his name on a banner hung over the main street and a crowd of youngsters, friends, former teachers, and family waiting for him at the high school, where he'd once been captain of the football team and student council president. As he moved inside the auditorium someone gripped his tumor-stricken right hand too hard, and he switched to shaking hands with his left.
He spoke first to the students, telling them that with effort they too could excel. "I understand that at home he never comes out of the bedroom, and I was surprised at his ability to stand and speak like he did," said Bald Knob mayor Earl Strickland some months later. Afterwards, refreshments awaited him in a school lounge. He was so tired by noon that he skipped the luncheon planned in his honor; when Rosemary got him back to Little Rock he went straight to bed. But to Bone March 21 was an elixir. "Probably that was the most meaningful day of my life," he told me.
In April Bone and chaplain Larry Burton joined in a lecture to students, faculty, and residents at Rush on death and dying. Bone appeared on videotape, but he managed to get to a seat in the front row, thanks to a cane and Rosemary's arm. Several donors, led by an unnamed colleague, endowed a $1.5 million chair in Bone's name at Rush, the interest on which will go to establish a center on the dying patient at the medical center. For the second year, in May Rush sponsored a Bone-inspired conference on end-of-life issues, with Mary Katherine as one of the organizers. Those in attendance at the Drake Hotel received a booklet called Reflections written by Bone. Published by the Evanston-based National Kidney Cancer Association, the handsomely illustrated booklet is written for dying patients and their families. It deals with nitty-gritty issues such as insurance, memorial contributions, hospices, and doctor-assisted suicide, an option he firmly opposed.
"Before we start I'd like to say a few words about Dr. Roger Bone," said Erich Brueschke, Bone's successor as dean of the Rush medical college, welcoming the conferees at the Drake. "This extraordinary human being and physician is dying in our midst. Because of his deteriorating health, he's unable to be with us today, but I'd like to publicly recognize him with a round of applause."
Back at his apartment, Bone, clad in a yellow T-shirt, was propped on pink and yellow pillows in his bed. The blanket pulled high and tight about him, he looked boyish and innocent, despite a hacking cough he couldn't contain. "I feel sorrow a lot now," he said. "I don't want to leave my family. I'd love to see my grandchildren, and I don't have any. I have some fear. You wonder what eternity is like and that sort of thing. How is the final end going to be? I hope for the sake of me and my family that it comes like it did for Beth in Little Women. She had a benign look on her face, and then she just closed her eyes."
I had promised Rosemary I'd be short; Bone needed his strength for the nurse coming to drain fluid from his chest. After 50 minutes I rose to leave. "Good-bye," he said in a firm voice, extending his left hand from underneath the covers. I shook it with gratitude for his courage and honesty.
Bone still talked Rush medical business with Stuart Levin, just like always. He told intimates he was hanging on until Cindy completed the semester at the University of Michigan medical school. "He was afraid his death would mess up her finals," says Larry Bone. Cindy earned high marks. During the Memorial Day weekend the Bone brothers watched the Bulls play on television; Roger had made his way from the bedroom to a recliner in the family room, walking slowing with a cane. "He cheered on Michael Jordan and the rest of 'em as if he was going to be around 100 years," Larry said later. "Roger's a tough old bird. Nobody thought he'd last this long. He knows death is inevitable, and he has made peace with it. His spirits are very good, probably better than yours or mine would be."
On May 29 Bone developed a fever of 105 degrees. He'd wanted to die at home, but "he'd taken a bad turn, and we couldn't let him melt in the bed," said Mary Katherine. Bone was admitted to Rush and tumbled, ironically, into septic shock. "The chances of his surviving the episode were less than 15 percent, but with antibiotics and other drugs, an old way of treating the condition, he prevailed," says Stuart Levin. "We were all amazed." Rosemary and the girls took turns staying with him as his blood pressure dropped and he drifted into incoherence. His new goal was to be around when the Bulls won the NBA championship; he would watch a quarter of a game, fade into semiconsciousness, and then emerge for the last quarter. By now "he was more a tumor than a person, and so very brave" says Levin. Powerful doses of liquid morphine were applied to lessen his pain, and he continued to crumble. "I'm not salvageable," Bone said at last, fulfilling a promise he had made to Larry Burton to indicate when it was over.
He had a rough night on Sunday, June 11. "Finally he got comfortable early that morning," says Mary Katherine. "My mom was with him. He closed his eyes and went to sleep." He died at 11 AM.
His funeral took place the following Wednesday at the First Presbyterian Church of River Forest. "His accomplishments read like a who's who in the world of medicine," said the Reverend Richard Latta. Bone himself appeared on videotape on a screen set up at the front of the church--Rosemary's idea. He was sitting on a high-backed blue chair, attired in a suit and tie, and looked so thin and drawn that he shocked associates who hadn't seen him in a while. "I should have depended on God rather than on myself, because depending on myself brought me to a meaningless existence," he said, echoing Ecclesiastes. A doctor friend later joked lovingly, "Of course, Roger would deliver the last lecture."
"Roger stayed alive as long as he did to accomplish something," says Leo Henikoff. "As a patient he realized that medicine in specific--and society in general--tends to turn its head from death. His contribution was to make us look this problem in the eye, to view death not as some kind of option but as a natural end to life." Three weeks before he died, Bone and his older daughter had a heart-to-heart talk in which she told him that she was miserable at Rush. "He gave me the OK to leave," says Mary Katherine, who's just started a new job at the American College of Chest Physicians. "He thought that in life you should be happy and be a good person." o
Art accompanying story in printed newspaper (not available in this archive): Dr. Bone photo by Kathy Richland.