My friend Tom Koslowski died Monday, January 12th 2015 from complications secondary to cancer. He died in his tiny, one bedroom apartment, a man alone, forgotten by most of the world. There was no hospice or visiting nurse at his side. His elderly mother found his body on Thursday. She called me on Friday. You will not see his obituary in the newspaper, nor will there be a memorial service, because Tom was a member of America’s invisible population of mentally ill citizens. He did not have two nickels to rub together, few friends, and no family besides his mother. He was sixty-one years old.
Tom was a paranoid schizophrenic who bore a marked resemblance to Tolkien’s character, Gollum. People instinctively recoiled from him, as though he were a ghoul. I will tell you right now, he was one of the kindest, most honest souls I have ever met, and as much as the ill-mannered stares and rude whispers from “normal” people hurt him, he never held a grudge or wished anyone ill.
In a life where he very heavily relied on government agencies, caseworkers, and healthcare providers, Tom came to hate being a burden to other people. He did not drive, was terrified of public transportation, and did not have the stamina to walk any sort of distance. Going to the store or doctor or pharmacy always required the reluctant help of someone else. Sometimes it was a government-funded taxi or the TriMet Lift, and sometimes it was a friend or neighbor. Regardless, Tom always had to work the phones and beg for the transportation that you and I take for granted. It embarrassed him and he hated it. Sometimes, if he were in a bind, I would stop by his apartment and drop off his prescriptions on my way home. I would always stay for an hour or so to talk and, most importantly, to listen.
When Tom was as a little boy he wanted to grow up to be a doctor. He wanted to help people. His symptoms emerged when he was nine years old and, instead of being the doctor, he became the patient. He suffered a lifetime of cruel tricks at the hands of the voices in his head, not to mention those wounds inflicted by the world around him. While Tom was often reluctant to talk about his adventures in life – most of our conversations revolved around his medical needs – once in a while, if he was in the mood, he would tell me a tale or two from his past. Sometimes the stories were painful, but sometimes they were downright funny. The pragmatic, self-effacing humor he spun into his recollections made Tom a good storyteller. His tales were good enough that I offered to write his biography. It would have been a best seller, and I am confident it would have been an honest accounting of his life. Tom declined the offer for fear of the pain of dredging up a continuous history, much to my regret but with my understanding. While he considered himself a worthless human being, his story would have been more interesting than 99% of the biographies ever written. He was a good man and he survived a life in a world we little understand and greatly fear. He was anything but worthless.
In deference to Tom’s wishes, I am not going to commit those stories he gave me to writing. There is but one story of his that I feel a need to tell and that is his last one. Last autumn, Tom had to make a decision to fight his cancer or let nature take its course. He was physically quite frail, and odds of him surviving the procedures and treatments were not in his favor. His oncologist and GP were pushing him towards treatment, so he came to me for advice. Medically, oncology is far out of the scope of my practice, so I left the clinical question alone. Instead, I asked Tom, “If you go through the treatments and survive, then what?” Tom knew what I was asking. We all die. Life is the leading cause of death. Did he want to be comfortable for six months? Or did he want to be miserable for eighteen months? At his age with his health, no matter what, death was relatively imminent and inescapable.
Tom took this final decision very seriously. He made it with a clearer mind and a braver heart than most of my sane patients. In the eight years I had known him, he had spent every minute of every day managing his health. Despite his mental illness and other health problems, Tom had learned to enjoy life and did not want to die in the least bit. If he had any fight left in his body, he would have fought. He simply didn’t, and he knew it. He opted to let the disease take its course.
As much as he could be, Tom was a good son and very much loved his mother. This is why he protected her as long as he could from news of his cancer, not wanting her to worry over him. Besides him, she had little in the world, and he knew there was time enough for her to have sleepless nights. The gift of ignorance was the only gift he had the ability to give, and he did it out of love. She found out a matter of weeks before he passed. She was likely a bit angry with Tom for keeping the secret as long as he did. I hope she understands it was an act of love on his part. He carried her part of his burden as long as he could.
Tom Kozlowski was more than my patient. Over the years we had become friends. Friendship is an odd thing, and is often found in the most unsuspecting places. I am a richer man for having known him, and that is no small thing. I hope that now, free of disease and pain, Tom’s soul can look down from Heaven and see how he touched my life. The little boy who wanted to grow up to be a doctor is finally free. As long as I live, I will not forget him.