I wondered whether the request would ruffle feathers with Minnesota’s army leadership, who would have to replace me, knowing there were other army officers qualified for such an assignment. The anxiety was misplaced. Major General Larry Shellito, the adjutant general of Minnesota, shared Caldwell’s email with me when it arrived:
Mark excelled as the Military Assistant to the Iraqi Chief of Defense during his last tour in Iraq. Based on his past experience and proven stellar performance, would like to offer him the opportunity to contribute as the Military Assistant to the incoming Afghan Minister of the Interior, Bismillah Mohammadi. His unique skill set and proven ability to navigate the nuances/ambiguities of this very non-standard mission would be an invaluable addition to the team here. We are entering a critical time in the Ministries and Mark could bring a tremendous vantage point.… General Petraeus and I have spoken about Mark, and if you are in agreement, would really like to bring him on board.… Letting Mark go would cause your team to go without, but if you are able to make this work we would be grateful.
General Shellito immediately approved the courtesy request. In fact, within a week, he approved my immediate promotion to lieutenant colonel.
At home, there was a peace and serenity unusual for a deployment. Kristin (she may be Mom to you, but she’ll be Kristin to me throughout this story) accepted the news with quiet resolve. She wasn’t excited about it, but she was completely unshaken. She was used to disruptive military life, but this time—for the first time in my career—she was right where she wanted to be during a deployment.
She was home in Minnesota.
Her sister and parents lived two and fifteen miles away, respectively. Both of our families were within an hour’s drive. She also knew that when I returned from the deployment, she wouldn’t need to worry about being moved to a new assignment and a new home, as we had after previous deployments.
I was being delivered to a promotion and a dream assignment with implications on an international scale. Kristin was as content as she had ever been with the chaos that is army life. You boys were getting to know your extended family in ways you never could before.
It might have been the happiest moment of my life.
The only remaining hurdle was self-imposed. Though already medically cleared to deploy, I wanted a more thorough look. Three years ago, I had been diagnosed with a bleeding ulcer, and this was no ordinary ulcer. Twice I had experienced a massive hemorrhage in my small intestine, and the first one nearly killed me.
Perhaps you remember eating Thanksgiving dinner without me in 2007 while I was in the hospital seven states away, or when my chair sat empty just after Matthew’s thirteenth birthday in 2009 while I was in the hospital. The ulcer slowly bled over the next eighteen months.
History told me I was due for another episode. It didn’t take much imagination to guess how things would end up if I hemorrhaged during a mission to some remote corner of Afghanistan.
As alarming as these incidents sound, I was tempted to blow them off. Two civilian gastrointestinal specialists said I had a non-life-threatening condition thousands of people learn to live with. Each one dismissed the idea that the trouble could be anything other than an ulcer, and I had no reason to doubt them. I had just moved about sixteen yards of mulch into our backyard (yes, with your help, Matthew), and I was running two miles three times a week. I did feel tired, but it didn’t seem abnormal. I was convinced I had an undiagnosed bacterial infection or a small aneurism near the intestinal wall.
It took a week to see my third GI specialist in as many years—Dr. Jake Matlock. He said the ulcer diagnoses from past doctors weren’t exactly wrong, but my symptoms demanded a closer look with the use of an endoscopy (a lighted scope lowered down the throat and into the stomach). I’d had this procedure twice before, so I knew what to expect.
After the procedure, Dr. Matlock came into my room wearing a bit of a poker face. He said he had found a fist-size lesion in my duodenum (small intestine just past the stomach). It was about ten times bigger than the ulcer’s description from the year prior. He also told me normal scores on a test measuring stores of iron in the blood run from 100 to 300. Mine was 2.
I didn’t need any translation on those numbers, but I still didn’t think I had anything a blood transfusion, antibiotics, and some cauterization wouldn’t fix. He ordered a CT scan.
Kristin and I returned the next day to discuss the results of the scan. We nervously chatted with each other as we waited. My mind was mostly elsewhere: my deployment clock was ticking loudly in my head, and I was focused on the new Afghan minister.
Dr. Matlock entered the room and quickly took a seat. His face was expressionless, and he wasted no time delivering his message. He spoke with a soft and compassionate voice: “Mark, I’m afraid the news is bad … really bad. The ‘ulcer’ is not an ulcer. You have cancer.”
The words seemed to come out of his mouth in slow motion. The scene didn’t seem real. It was more like the set of a movie, with me playing a character. I tried to discount the significance of the news, but the CT images wouldn’t let me.
“This entire area here, where the stomach connects to the intestine”—he pointed to the duodenum, pancreas, associated ducts, and the surrounding lymph nodes—“is simply indistinguishable from the surrounding tissue.” The mass extended up into roughly 75 percent of my liver—about fifteen tumors of all sizes. The tumors in the left lobe of the liver were the size of golf balls, and those in the right lobe were the size of dimes and nickels.
This explanation took only a minute or two. When he glanced over at Kristin, he stopped speaking, and the look on his face told me why. The memory of the look on Kristin’s face still grips me by the throat and overwhelms me every time I think of it.
Her entire manner was that of a completely terrified ten-year-old girl. She was at the edge of her seat, sitting up straight, staring wide-eyed as tears streamed down her face. Her lips curled into a big frown and quivered as she very softly asked Dr. Matlock, “Our boys aren’t going to have a dad?” He did not answer. She turned to me, looked deep into my eyes, and squeaked out in the same voice, “We were supposed to grow old together.”
I tightly gripped her hand and just kept repeating in a determined voice that everything would be all right. What the hell did I know.
I was stunned, but not yet overwhelmed. An army credo came to mind: “The first report from the battlefield is always wrong.” The reality could be better, it could be worse, but the first report was almost always wrong. As far as I was concerned, we needed to focus on getting the rest of the story, not planning my funeral.
Dr. Matlock then said something sympathetic, but self-evident: “I don’t think you’re going to be able to go on that deployment.”
No kidding, Doc. No kidding.
He suggested the Mayo Clinic in Rochester, just ninety minutes away, but the discussion trailed off, because Mayo was not in my insurance network. I told Kristin we could sort things out at home.
We had driven separately to the appointment because Kristin had come directly from work, and I worried about her driving home alone in such a highly emotional state. I had never seen her so visibly shaken.
When I got home, I walked in the door, primed for an explosion of grief and rage, confusion and fear. I was way off. This unassuming and normally soft-spoken woman had been busy on the phone the whole ride home. During her fifteen-minute drive, she had managed to secure a comprehensive set of appointments two days later at the Mayo Clinic: GI, oncology, and surgery—she had them all.
“We ain’t waiting on Tricare,” she said with conviction, referring to our insurance company. Her tone told me she knew I might object. I asked how she had gotten all of this done without a formal diagnosis or medical referral.
“I wouldn’t take no for an answer.”
My soldier’s heart doubled in size. That is an army wife, by God. It was also one of the most powerful examples of strength and courage in the face of fear I
have ever seen.
Strength. Weakness. Bravery. Fear.
I sometimes wonder if we think too seldom of what these words mean. We’re taught early on in life that being afraid is something to be ashamed of. This is wrongheaded. Fear is healthy. Fear keeps us alive. When I went through the army’s airborne and air-assault schools and learned to jump out of planes and slide down ropes hanging from helicopters, I did not want to be sitting next to any trooper who wasn’t just a little afraid about what he or she was going to do.
Bravery, then, is not about avoiding fear or finding ways to ignore it; it’s a reflection of what you intend to do with your fear. Facing it means taking in everything about your situation—the good and the bad—and figuring out what you are going to do about it. Anything else is just a variation of surrender.
Strength is about getting something done, even when you have ironclad excuses or reasons for not doing it. Your mom has a hard time seeing how she exemplifies this, but she has shown it to us every day. She can feel her weakness, and that scares the hell out of her, but as sad and as upset as she is about what life has handed her, she never loses sight of what must be done to care for her family and for our home.
What will you do when those moments arrive in your life?
Chapter One
… NOT TO SEEK THE PATH OF COMFORT, BUT TO FACE THE STRESS AND SPUR OF DIFFICULTY AND CHALLENGE.
1994, grandparents Franny (left) and Mat (right) at graduation
JULY 2010
The entire medical team at the Mayo Clinic was unanimous in their assessment: there was no path of comfort. The team proposed a massive and radical surgery called “the Whipple-plus.” The Whipple would remove the mush that was left of my duodenum, the bile and pancreatic ducts, the head of the pancreas, the surrounding lymph nodes, the gallbladder, and maybe more, depending on what they found when they cut me open. The “plus” would remove 60 percent of my liver but only half of the cancer, with plans to come back for the rest later.
The doctors were incredibly upbeat, but they offered more conditions and caveats than a car commercial.
Forget the cancer. The surgery alone would result in months of severe physical disability, an overnight change in lifestyle (eating, activity, leisure, work, social interaction), and just as much cancer would be left inside my body as the doctors planned to take out.
The doctors on my Mayo surgical team performed five Whipples per week, but they didn’t conceal their inexperience with the Whipple-plus or sugarcoat its risks. With the surgery, I might die soon, they said; without the surgery, I would die soon.
It wasn’t a hard decision for me. If I was going down, I would go down fighting.
When an army is about to go on the offensive, there is nothing more motivating than a rousing set of remarks from the commanding officer. I decided to rally my small army of supporters in the same way. The inspiration for what to write came to me one morning just as I opened my eyes. By 0600, I was feverishly typing out my own adaptation of General George Patton’s remarks to the Third U.S. Army on the eve of D-Day, the largest invasion in world history. My rally read, in part:
At ease! (which means “Listen up!”)
Now, I want you to remember that no one ever won a war by dying for his country. He won it by making the other poor dummy die for his country. Family, friends, all this stuff you’ve heard about cancer always winning the fight … is a lot of horse dung.
You know, by God, I actually pity those poor cancer cells we’re going up against. By God, I do … We’re going to murder them by the bushel.…
Thirty years from now, when you’re sitting around your fireside with my grandchild on your knee and he or she asks you what I did in the year 2010, you won’t have to say, “Well, he sat around and felt sorry for himself in Minnesota.” …
All right now, you know how I feel. Be strong with me. Fight with me. Oh, and I will be proud to lead you wonderful guys into battle—anytime, anywhere. That is all.
It was not lost on me that Patton had survived a thirty-six-year army career and two world wars only to suffer an inglorious death from injuries sustained in a car accident four months after the end of the war. Now it looked as if I might survive combat and twenty-one years in the army only to succumb to cancer at age thirty-nine.
More than that, I realized that war speeches may sound great to adults, but they don’t play so well with children. When deciding how and what to tell you boys about the cancer, we decided early on that if you were expected to endure the crash landing, you had better be on board for the takeoff.
Bad news does not get better with time. Sooner or later, the people you know and love are going to find out. Who do you want them to hear it from—you or someone else? And if they hear it from someone else, what are the chances your bad news becomes something worse—such as a conversation about why you kept something so important from a loved one?
Keeping things quiet until we had more information was not an option for us, because the information was floating on Facebook like a stray bullet. Thankfully, Joshua and Noah, you were only ten years old and had no cellphone or computer, and Matthew, you were in New Mexico at the Philmont Boy Scout camp, where there was no reception. We needed to get to you before the news did—but not before you finished your camp.
Philmont is a rite of passage for scouts, and you were only a day or two from completing it as a fourteen-year-old. You had already hiked seventy-five miles and seven mountain peaks with a fifty-pound pack over eleven days, every single day in some rain, and three full days in rain and fog. The last thing I wanted you to hear as you reveled in this amazing achievement was an accidental “Hey, sorry about your dad” from one of your comrades or scout leaders.
My deployment provided a perfect cover story, and I swear I could hear the theme song to Mission: Impossible in the background as we went to work. We ensured you were whisked away as soon as you came off the trail, and then we disabled your phone and shut down your Facebook page.
With all you boys home, and with a plan in hand for what would come next, we broke the news. In reflecting upon what and how much to share, we kept in mind that entire books had been written on this subject. We knew we had to separate the things that needed to be addressed now from the things that could be addressed later.
One question ended up guiding our thinking: What were you going to see or hear in the next two to four weeks?
Since there’s almost five years of age between you, we told you separately—first Matthew, then all three of you together. We gave you the same message but presented it in different ways, based on your age and personality. Because of our army life, this wasn’t the first time we’d had the “what if something really bad happens to Dad” talk. And before each of my deployments, we had discussed the immense responsibility you needed to assume while I was away, whether I survived or not.
I organized my thoughts in writing and rehearsed before talking to you. “Boys, I know you’re smart little buggers, and you’ve probably noticed a lot of stuff going on around you this past week, right?”
Noah, you slowly nodded and commented, “I have seen Mom’s face looks red around the eyes a lot.” You also commented about the number of sad people you saw coming and going. You added, “And I think I heard Grandma Coughlin say something about you and cancer when she was on the phone last week.” I wasn’t mad about this misstep, only reminded that kids see and hear more than we think.
The calm in your voice told me you knew the information but didn’t understand it.
“I do have cancer,” I said. “I know it doesn’t look like it, but I am very, very sick inside.”
Your face transformed much like Kristin’s had in the doctor’s office. You started sobbing and reached for Kristin’s leg. I stopped. Joshua and Matthew, you sat stone-faced, but I know well that you are introverts, and that you were processing that same emotion inside. I felt I needed to acknowledge it all before continuing.
“Why are you crying?” I gently
asked you, Noah.
“Because you’re gonna die,” you said as you rolled your eyes.
I tried to address all three of you in my reply. “Well, that’s part of why Mom and I are talking with all of you now—to help you understand what’s happening. I won’t lie to you. I might die soon, but I’m not dead yet, and I have been given a chance that lots of people don’t get.”
Then I deliberately switched to a stern voice—the one I use for discipline. “I’ve been given a chance to fight, boys, and that is exactly what I’m going to do. You need to know this fight is going to be pretty easy right now—getting smart about this stuff and doing good planning, strategizing, preparing. But it’s going to get a lot harder. In a few weeks, you’re going to see your dad knocked down hard, and I’m going to be in the hospital for a long time. I am going to look … rough. Those will be the days that I may not look like me, but I’ll be in there—fighting.”
I switched back to a much softer tone. “You may not see me cry much, but I do cry. I get scared, and I do get mad about this cancer thing. You’re probably going to experience those same feelings, and you need to know that’s okay. It’s okay to be sad, mad, frustrated, scared, and even to enjoy a little denial every once in a while. But you cannot stay there.”
When I was a young soldier, I explained, we performed training missions that lasted all day and most of the night for up to a week at a time. “When someone on the team got tired, we stopped and we took a knee to rest. But we always got back up, and we never quit … never. Just like those young soldiers, we can all take a knee too, but if we don’t get back up and move out, we’re likely going to die or fall to pieces in that place.” I told you that soldiers aren’t always happy about doing it, but we do what must be done.
Tell My Sons: A Father's Last Letters Page 2