The Last Lesson
by Ricardo T. Rosenkranz, M.D.
“Every miracle has its price” —Eugene Burger
Many people have known Eugene longer than I. We entered each other’s lives relatively recently, in 1999. Many words will be written about Eugene, the man, the magician, the sage, the father to ten thousand sons, as Jeff McBride has said. And I am but one.
It is, nonetheless, my purview and responsibility to tell you about this one last lesson. This is a story that only I can relate for it was my charge, my deepest obligation, my heaviest burden. And if to the untrained eye it seems that I have broken the most sacred bond of doctor-patient privacy, it is because Eugene wanted it so. One day, when he was no longer able to speak with his silvery voice or dip his ink with the feather of wisdom, I was supposed to share this story. It was perhaps, his last request.
I dialed the familiar number on a June afternoon.
“Hello,” he answered with that characteristic rumbled descending intonation. He knew it was me, perhaps because he saw the caller ID, or perhaps because, predictably, he expected the call.
“I’m leaving now, so it should be a few minutes; sorry I’m late.”
“That’s okay” he said.
He was never snarky, annoyed, or impatient. And I was late all the time: the life of this doctor. But this time it was not due to an emergency phone call, or going home to pick up the prop that I was supposed to bring along to our session. And it wasn’t due to simply losing the battle against the watch. This time I understood that this walk would be a different journey. It was the first time we were going to speak about The End. Reticent, I left my home for the seven-minute journey to Eugene’s door.
I walked out of my building and as I felt the humid June breeze, I remembered the first time he and I had spoken about his death. In 2009, after he had been hospitalized for a few days with an arrhythmia, Eugene and I had lunch at The Drake Hotel to celebrate his discharge.
After a few laughs Eugene turned serious, “I want to ask you to do something for me; it is very important.” He looked at me and began, “I have lived longer already than anyone in my family. Though I am adopted, I never expected to live to be over fifty. And now I am approaching seventy. I don’t want to live forever. And I certainly don’t want to witness my own decline. Please make sure that when my life is inevitably in decline, and I retire from the public eye, that you will help to make my death quick, painless, private, and anonymous.”
“Well sure, but . . .” I responded, intending to allay his concerns.
“No, really! Will you do this for me?” He interrupted me pre-empting any doubts or protestations I might offer.
“Of course I will, “ I responded reassuringly.
Eugene sat back, offering me that smirky asymmetric smile, the one that launched one thousand applauses. The smile that came after “Bon Appétit” in “Thirteen for Dinner,” or “Amsterdam” in “Voodoo Poker.” It was a complex expression of satisfaction and mischief, all bundled into one facial nuance.
And so I was ordained, anointed, burdened. Someday, in the hopefully distant future, I would be the guardian of Eugene’s dignity, serenity, and tranquility. Subsequently, we didn’t speak of it too much. And yet, we did speak often about death, as if carving a shape familiar to our hands, unchartered to our eyes.
Eugene’s request was not the first or only one I carried at that time. My brother, a few years older than me, had been diagnosed with pancreatic neuroendocrine tumor, a type of slow growing pancreatic cancer. His request was the same, but there was a name to the illness that would fell him. My job was to preside there, too, protecting him from pain and suffering. In 2011, I did, and my brother left us peacefully, devoid of torment.
I had shared the details of that episode in my life with Eugene. I described with profound detail the last two months spent sleeping in hospital chairs, the countless decisions, large and small, all with mirrored objectives: dignity and closure. I offered those stories to Eugene because in so many ways he was my North, but also because I had come to understand by then a very private truth about Eugene understood by less than a handful of his closest friends. Eugene, the venerable expert in spirit magic, the unequivocal source on séance, the master of a magical life, was busy writing the script of his own death. He wasn’t hastening it, he wasn’t choosing the set, the theater, or the date. Eugene loved life; he was never in a hurry. But he was never going to be caught unprepared and without a meticulously written script. So he was writing the script and I was to be the director. Hearing about my brother’s passing was reassuring. I guess by then, my resume offered Eugene a measure of tranquility.
My feet knew the way to 1260 N. Dearborn without my eyes. One block, then two, then two more. And there it was before me. The familiar dial pad at the building’s entrance. How many times had I dialed those three numbers with excitement and joy? Despite the frequency in those eighteen years I had never lost the thrill. Eugene’s apartment was my happy place. It was my safe space. When the outside world threatened to collapse, 1260 N. Dearborn, Apt. 105, was a temple of transformation, a sanctuary of rebirth. Today, I was not bringing a bag with a new prop that Roland (my dear woodworker) had created. I wasn’t bringing a new script or new show order for us to revise. There was no new Norm Nielsen Okito-fíed box that I was bringing as a gift. In my bag was a different kind of gift. A piece of paper downloaded from the electronic medical record, scribbles with names and numbers on the margins, and a citation of a recent review article.
For the first time my fingers hesitated to dial those three numbers. I was already late.
I stepped back and went outside to gather myself.
During all those years I had helped Eugene with medical matters, large and small. He had a cardiologist who took good care of him. His cardiologist and I spoke frequently, and things had been very stable for years. In December of last year Eugene had started limping and by March it hadn’t gone away. I had finally convinced him to see one of my colleagues. In June, celebrating his birthday in his favorite Chicago restaurant, we had noticed he was tired and short of breath. I thought it was cardiovascular. Eventually he agreed to hasten his visit to the Cardiologist. But the piece of paper I had in my briefcase was not a cardiology report.
I cleared my throat, wiped my eyes, and gathered my strength. I went back in and pushed the code to go inside the building.
Stairs up one floor, corridor to the middle, and almost as if by magic, as I was about to grab the doorknocker, Eugene opened the door.
He was wearing a loose hanging short-sleeved shirt with a pattern and black pants, of course.
“Hi!” Followed by a hug, that peaceful flat grin from ear to ear and that unusual unintelligible seal-like utter he made when hugging you with love. You’d think this was a normal day. But we both knew it wasn’t.
I sat down, opposite him separated by the desk, just as I had a thousand times before. This was a day we would both remember.
“Let’s talk,” I said, leaning forward.
“Sure,” Eugene said, shrugging his shoulders, closing his eyes, and nodding sideways while leaning back.
And as the patient teacher who already knows what his student is going to ask, he anticipated what I was going to say. In fact, he was making it easier for us to have this talk. Not that it wasn’t going to be easy, because Eugene and I enjoyed a profoundly open relationship. I was going to be direct and straightforward and he was going to be serene and composed. And, I must add, I’m seasoned at this sort of conversation.
“You have a tumor in your left lung. We don’t know yet what it is, and depending on the cell type we can see what therapeutic options might be available.”
Before and during the lung biopsy, Eugene had already vaguely heard the words “tumor in your lungs.” But just as in magic, nothing ever happens until it is truly, clearly spoken. And this had not been spoken yet.
At that point, Eugene looked at me with the sweetest, most gleeful smile. There might even have been a glimmer in his eyes . . . and so the last lesson began.
For as long as I can remember, I had sat opposite Eugene at that table and we rarely touched. That day, as if building a bridge of love, and reassurance, his hands crossed the middle of the black desk and took my hands. With that beautiful voice, he spoke reassuringly in his unique melodic style.
“It’s okay. Ricardo. I am at the top of my game. I never thought that I would reach fifty years of age and here I am at seventy-eight having done everything beyond my wildest dreams. As we have discussed so many times, I’m really looking forward to the one mystery left for me. The Capital “M” Mystery of life. And I’m really looking forward to it. Look, I’m not completely an agnostic, so I’m excited to experience what others report happens at The End. And, though some people say that at the end of life all that imagery is just a bunch of neurons firing haphazardly, I’m okay with that, too. Neat!”
Without skipping a beat he continued.
“Perhaps my role in life, my last role in life, is to teach my friends how to die.”
We looked at each other quietly for what seemed like an eternity and yet was probably a fleeting moment slower than his own “World’s Fastest Card Trick.” And in that universe of a second we both cried, profoundly, primordially, painfully, lovingly. And that was it. That was the only true “all things revealed” moment in the entire lesson. That was the instant when the beautiful veil, crafted like a Rice Silk, was torn, irreparably split in two. And there was no magic capable of healing it. Together, we both peered for the first time into the other side.
While I learned myriad things from Eugene, he also learned a few things from me. In my own medical philosophical teachings, I explain to my medical students that in life when we become aware of our ephemeral nature, we ultimately have two questions that effervesce to the surface of our consciousness: When will I die? And what will be the cause of my death? Because we cannot carry these questions with us daily, we create an illusion of health about ourselves. It’s a therapeutic concealment if you wish. We take a veil, textured with our beliefs, and place it over these two questions in order to forget them. When Illness appears, the veil is torn. Sometimes it’s just a small cut that can be repaired. Sometimes it is ripped irreparably.
This, then, was the moment when Eugene’s veil was torn to pieces. It was the moment when the primordial mystery of these quintessential questions approaches near total revelation. And so we took a moment to mourn the loss of the veil. (In Eugene’s case, it had probably been a 6’ x 6’ Rice Butterfly silk.) Holding hands, we could see the other side.
Just then, my phone rang. It was Eugene’s doctor, his cardiologist. He was calling me with the report I had just downloaded, now updated with the name of the offending cell: Squamous Cell Carcinoma. He wasn’t aware of it, but Eugene could hear the whole conversation. Eugene’s doctor was beside himself, tortured with a bad diagnosis. Conventionally forlorn with the angst of bad news for a patient loved and respected, Eugene’s doctor was preparing himself to call and deliver the bad news. My eyes met Eugene’s. We both nodded, having communicated non-verbally just then. I reassured the cardiologist. releasing him from that duty. I would play the role of Hermes.
And yet, in my case, I was free as a bird. There was no executioner here, this was not a death sentence, dreaded and feared. In Eugene’s enlightened vision, this was simply a vessel for transformation. This transformation long expected, welcomed with wisdom, was not an uneasy guest at a dinner party. It was an invited friend, asked to stay, no matter the consequence as long as he or she didn’t detract too much from the merriment.
And so there it was, Squamous Cell Carcinoma. The words were spoken; the spell was cast.
As easy as it was for Eugene to speak freely with me about death, he found it much harder to contemplate the task of sharing this news with his friends. So it was decided that at the appropriate time I would call everyone in Eugene’s horizon and explain circumstances and plans. For someone who had shared an artistic and philosophical vision of death, Eugene turned to compassion for others. It’s not that he was avoiding difficult conversations. Rather he knew that in my choice of words, comfort and context would find their way into everyone’s hearts. For this burden I was thankful.
Plans were created, strategies were elucidated, I stood up and we hugged. I left for home.
As I was walking, it occurred to me that in my entire medical career, no one had ever said they were looking forward to this Capital “M” Mystery. Sure, many might have defied death empirically. And of course there are many individuals who harbor a death wish for various reasons. Eugene’s story was altogether different. Here was this master of mystery, master of magic, finally finding himself at the threshold of a distant door, frightening to most. But seeing his eyes and hearing his voice, you could almost sense that standing before me was a lovely little boy about to enter Joe Berg’s magic shop at 30 West Washington Street in Chicago. That was the first real magic shop he ever visited.
Days and weeks ensued. It is important to understand that Eugene wasn’t giving up on life. In fact, we made no decisions until the extent of the illness was fully elucidated. Eugene was engaged with the prospect of therapy as long as it was not futile. Surgery was contemplated and other options, too. No one was notified just yet. And then, sixteen days later we added three more words to “Squamous Cell Carcinoma.” They were “stage,” “four,” and “metastatic.” I heard these words first on the phone, from the surgeon. We discussed the various lesions in the PET scan as if they were cities, rivers, and oceans on a map. He offered increasingly desperate options, and I downloaded a few more research articles. I called Eugene and walked over to 1260 N. Dearborn. Seven minutes, five blocks, three words, one embrace. We had seen each other almost daily in the interim. He was weaker. There was pain now, and it wasn’t going away. The newly downloaded map of tumor coincided with the pain. And so here it was. I was no longer the protector of the veil, I was now the boatman, tasked with delivering Eugene safely and painlessly, with dignity and anonymity to the other side of the river.
In June, the first mystery was revealed: the likely cause of Eugene’s demise. And now he inquired about the second primordial question.
“How long do you think I have?”, he calmly asked.
“I don’t think you will be here in 2018,” I responded.
“How about Halloween?” He loved that night.
“Not sure . . . perhaps,” I replied.
“Call them,” he asked.
Up to this point only a very few of us knew of his illness. Included in that handful were those who took him shopping for food, waited in hospital lounges with him, and ministered to his pain.
Part of his last lesson of teaching us to die was finding a way towards anonymity in the midst of his own celebrity. Eugene understood that in order to preserve the anonymity so cherished by him at this moment he had to differentiate between a hierarchy of the people who he loved and a hierarchy of people who really needed to know. Alas, at this juncture the hierarchy of love had to fall subservient to the hierarchy of information. In his modesty and wisdom, Eugene wanted no vigil, no wake, no broken wand ceremony. He wanted to preserve everyone’s memories of him. So the hierarchy of information, based around immediate, pressing service, was invoked by me.
There were a few more visits to the doctor. And five days before his passing, Eugene performed “B’Wave” one last time for an audience of marveling nurses and physicians in an outpatient clinic. He truly was a working magician until the very end.
During these final weeks Eugene turned his vision and wisdom inwardly. It is not that he was withdrawn, and it wasn’t because we were managing his pain. He still had a cheerful disposition and a fiendish sense of humor. One of Eugene’s closest friends, Michael Caplan, upon hearing about the diagnosis from me, called Eugene and said,
“I hear you are dying.”
To which Eugene replied without missing a beat, “Aren’t we all?”
There was something about Eugene that I had not seen before in anyone else, not any patient, and not even my brother. And in a few days it would take my breath away.
In early August I suddenly had to leave Chicago for a family emergency. A few days later, on a Saturday afternoon, I called Eugene. Robert Charles and Mike Burke, two of his closest friends now turned caregivers, answered the phone. They had arrived for an early lunch with Eugene and were very concerned. We face-timed. Upon seeing Eugene on the screen of my iPad, I instructed him, Mike, and Robert to go to the Northwestern ER. I called the triage nurse, the oncologist, and the palliative care team.
It was too early for the tumor to be causing this much havoc; most likely it was the pain medication. Nothing prepared me for what followed.
Mike and Robert became my ears and eyes in the hospital, tending to Eugene’s every need. Robert called and put the physician in charge on the phone.
“Hi, Dr. Rosenkranz, this is Dr. X from the ER. Mr. Burger has signs of sepsis, his blood pressure is low, and he is in acute renal failure….Dr. Rosenkranz? Did you hear me? Creatinine is 3.5.”
In nearly thirty years as a practicing physician I have never lost my breath. I have witnessed everything from the dreadful to the wondrous and had never inhaled like I did just then. I actually heard my inward gasp. How can I explain what I felt in that moment? It was the agony of a stabbing knife mixed with the elation of an unwrapped gift. I felt the deepest sorrow for those of us staying behind and the utmost joy for Eugene. For here he was, finding a way to go before the tumor struck in pain with an iron grip. Eugene was the master of life and now, before my very eyes, he was the master of death.
In his inward gaze Eugene had somehow found the way out. Renal failure was at hand, unlikely at this stage of his illness, but offering a blanket of compassion and kindness to anyone who might invite her in.
“By all means enter,” was the thought on my mind. “Play with Eugene, be swift and true.” With a creatinine this high, Eugene would serenely pass in short order. “Lighten up, Ricardo,” I thought to myself. Separately, I thanked the ER doc and asked for a special room for Eugene. I asked for a room with privacy, space, and a view.
Inexplicably, throughout his few hospitalizations, Eugene had enjoyed the rooms and food of Northwestern Memorial Hospital. He was often giddy with delight. I knew at this point Eugene was not going to be able to go home with efficient pain management, and so I managed to get him the next best thing. A lovely room, palliative care, and a morphine drip.
That night at Northwestern Memorial Hospital, room 1419, there was a sausage and cheese pizza from Pizzeria Uno, procured by Robert. The layout of this corner suite actually resembled Eugene’s living room. The bed placement allowed him to be presiding, as he always did, from the same place where his desk might have been. The moon was waxing near completion, and in the morning the sun rose over the lake right through Eugene’s window. There was love, the hierarchy of care was fully in place, there was dignity, and there was anonymity. I made sure there was pain control as well. So Eugene was calm and happy.
I remember reading the note written by Eugene’s palliative care physician on the electronic medical record:
“Mr. Burger looks forward to discovering the Capital “M” Mystery of death. He would like to fully experience the transition if possible but realizes that pain management might be necessary and prefers to be pain free above all.”
I knew that. I fought for that. We had allies and they were on our side. Eugene was present as long as possible and then he was peacefully sleeping.
When the moon was no longer waxing or full, in fact nearly a day into the waning moon, Eugene stood at the threshold and stepped into Joe Berg’s magic shop on Washington Street with all those freshly made Okito boxes. He stepped into the second floor of the Treasure Shop on Randolph Street where Don Alan sold him apparatus. He stepped into Abbott’s Chicago Store in the Woods Building where his oldest friend Jack Gould used to demonstrate. Eugene stepped into the attic in Evanston, into the myriad stages around the world that were blessed with his presence. He stepped into the living room at Jeff McBride’s Magic & Mystery School in Las Vegas. And then seeing everything that was lovely and beautiful in the universe he created, he retired, pleased with his eternal play.
“Perhaps my role in life, my last role in life, is to teach my friends how to die,” Eugene had said to me in June.
In August, I had completed my mission. He was delivered, dignified, anonymous, and with a fairly painless transition. It is ironic that my professional life is about transitions. As a Neonatologist I mostly help people transition into this world. And yet as a brother, friend, doctor, guide, and student I have helped many individuals transition out of this world. I often say that medicine is the sister to magic because it is, above all, a craft concerned with the most wondrous of human conditions, human transformation.
But in truth, while I took care of the earthly matters, Eugene was frankly ethereal. He taught us all the final lesson. He showed us how to embrace the unknown with passion. He modeled for us how one might dispose of fear through love and learning. He untethered the ship of transformation without hesitation or self doubt, setting it free to sail with neither haste nor delay.
Wise would we all be to heed Eugene’s last lesson. When a life is lived truthfully, honestly, and fully, when our life has enriched our days beyond belief, more is not necessarily more. When we embrace transition and understand it as transformation we unburden ourselves into a higher quality of living. When we unburden our loved ones through unconditional love and cut loose from conventional self pity, we are never alone in our journey.
The sage wrote his final script with a skill he had mastered and used so many times before. It was a tight script. It started with a probing question. It didn’t have two introductions and two codas. It was sparse, economical, succinct. Eugene avoided the belabored story brought on by unnecessary chemo or radiation. He avoided bringing more people to the stage than needed for the performance. And of course, in the end, as he did untold times before, the script had a brilliantly simple closing line, where Eugene alone would be left on stage with open arms, an unbroken thread of memory held by his fingertips.
I saw the script unfold. I saw this final magic offering unravel before my eyes. Being the very last person to leave the room after this greatest performance was complete, I stared at the waning moon shining through the window of room 1419. And as I turned towards his face, that silver beard of wisdom, now engaging the Capital “M” Mystery, was framing a smile of eternal love and satisfaction.
The lesson complete, I walked away as if this was Apartment 105, 1260 N. Dearborn. Until we meet again, Dearest Friend.