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We Know How This Ends

We Know How This Ends: Living while Dying

Bruce H. Kramer
with Cathy Wurzer
Copyright Date: 2015
Pages: 208
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  • Book Info
    We Know How This Ends
    Book Description:

    2010 had been a very good year for Bruce H. Kramer. But what began as a floppy foot and leg weakness led to a shattering diagnosis: he had amyotrophic lateral sclerosis. ALS is a cruel, unrelenting neurodegenerative disease where the body's muscles slowly weaken, including those used to move, swallow, talk, and ultimately breathe. There is no cure; ALS is a death sentence.

    When death is a constant companion, sitting too closely beside you at the dinner table, coloring your thoughts and feelings and words, your outlook on life is utterly transformed. The perspective and insights offered inWe Know How This Endsreveal this daily reality and inspire a way forward for anyone who has suffered major loss and for anyone who surely will. Rather than wallowing in sadness and bitterness, anger and denial, Kramer accepted the crushing diagnosis. The educator and musician recognized that if he wanted a meaningful life, embracing his imminent death was his only viable option. His decision was the foundation for profound, personal reflection and growth, even as his body weakened, and inspired Kramer to share and teach the lessons he was learning from ALS about how to live as fully as possible, even in the midst of devastating grief.

    At the same time Kramer was diagnosed, broadcast journalist Cathy Wurzer was struggling with her own losses, especially the slow descent of her father into the bewildering world of dementia. Mutual friends put this unlikely pair-journalist and educator-together, and the serendipitous result has been a series of remarkable broadcast conversations, a deep friendship, and now this book.

    Written with wisdom, genuine humor, and down-to-earth observations,We Know How This Endsis far more than a memoir. It is a dignified, courageous, and unflinching look at how acceptance of loss and inevitable death can lead us all to a more meaningful and fulfilling life.

    eISBN: 978-1-4529-4518-7
    Subjects: History, Public Health, Sociology

Table of Contents

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  1. Front Matter
    (pp. i-vi)
  2. Table of Contents
    (pp. vii-viii)
    (pp. ix-xiv)
    Cathy Wurzer

    The request reflected the stark and sharply cold day outside. It was delivered with an understated urgency as a column of brilliant sunlight illuminated the small den.

    “I’d like you to deliver the eulogy at my funeral.”

    The request was simple and should not have come as a surprise, but the words, and what they meant, made my stomach clutch. I was trying to find my breath and the right words to say, all at the same time.

    Bruce Kramer sat quietly and waited for an answer. Waiting is what Bruce is forced to do. His motionless hands were placed...

    (pp. 1-7)

    2010 was a great year. In no particular order, I completed my second year as dean of the College of Education, Leadership, and Counseling at the University of St. Thomas, my wife was happily teaching music in a French immersion elementary school, my sons were getting themselves together—each had found a life partner, and we knew it would be just a matter of time before they got married. We had two cats, I was a bike commuter, I rode the MS 150 to raise money for multiple sclerosis, Ev and I spent a month in Indonesia playing Indonesian gamelan...

    (pp. 8-14)

    Unexpected, unwanted, or shocking news can sear itself into your brain. The circumstances of where and when the news was delivered: the sights, sounds, smells of whatever was happening at the time comingle with the shock and leave indelible imprints in the strangest ways.

    That is why I remember the dragonflies.

    After getting the phone call that my father had been diagnosed with Alzheimer’s disease, I went outside to absorb the news in a forest-green rocking chair badly in need of a coat of paint that Dad and I had assembled with great difficulty some years before. I was a...

    (pp. 15-21)

    Most of us live our lives according to an unspoken set of assumptions. We assume, for instance, that we’ll make good money, live in good health, and enjoy good friends, good sex, and a good time before dealing with the endgame when it comes. Of course that is a gross simplification, but you get the idea. Many of us assume our loved ones will also enjoy robust health and well-being. I assumed my parents would live into old age in relative good health, only to die peacefully in their sleep.

    We experience a rude awakening when those assumptions are turned...

    (pp. 22-27)

    Ever watch young children at play? It’s uninhibited, spirited, and noisy, and in the process some tender feelings can get hurt as youngsters learn how to get along with one another. Kids tend to make friends easily. Adults find this task harder.

    Busy schedules and lives that aren’t as rooted in a single place make starting and maintaining friendships challenging. Adults are also more cautious, selective, and fearful—traits that can quickly slam the door shut on a budding friendship.

    How then do two people who first warily circle each other engage in a deeper relationship? It involves intricate choreography...

    (pp. 28-33)

    Webster’s Dictionaryis clear and succinct in its definition ofdisease: a condition that prevents the body or mind from working normally.

    In the case of ALS (amyotrophic lateral sclerosis), also known as Lou Gehrig’s disease, the motor neurons in the brain and spine that communicate with most of the body’s voluntary muscles stop functioning normally. They die off. Communication between the tiny cells serving as a pathway from the brain to muscles is severed, and the muscles wither and decay down to the ones that, ultimately, help us breathe. It isn’t known yet what causes this slow die-off of...

  9. 6 FAITH, PART I: Fulfilling What Is Meant to Be
    (pp. 34-38)

    In October 2012, Bruce quit working. For the first time in forty-five years he didn’t get dressed and head out the door for another day of work. He had continued to shoulder the heavy responsibilities of leading the College of Education, Leadership, and Counseling at the University of St. Thomas after being diagnosed, preferring to continue to work on behalf of budding educators rather than give in to the growing demands of ALS. But after twenty-two months, the disease had sapped his strength to the point where he needed to step aside. As was his custom, Dean Kramer carefully crafted...

  10. 7 THE TELL
    (pp. 39-43)

    I make my living talking about all manner of things, so I am no stranger to bad news. My career is based on it. Each day, I bring to my listeners a smorgasbord of difficult, disturbing, sometimes even horrifying stories of death and destruction, catastrophe, and cruelty. It is my job to calmly relate the news, the good and the not so good. I have done this for so long that I’ve developed a journalist’s callus: the attitude that bad things happen, and I will matter-of-factly tell you about them. It has to be something pretty big to shake me....

    (pp. 44-50)

    Given demographics and statistics, if you are not a caregiver to an ill or disabled loved one right now, odds are good you will be. As the population ages and greater numbers of people develop chronic illnesses, more health care is happening at home with relatives and friends stepping up to help. Caregiving isn’t a role many of us choose: it seems to choose us. Once immersed in the experience, we find—very quickly—that nothing is easy about caregiving and that it will only get harder. It is physically taxing, time consuming, emotionally draining, and ultimately life changing.


  12. 9 THE GIFT
    (pp. 51-58)

    Even the best of guidebooks to living with disease don’t mention the gifts that await the patient, the recipient, the so-called victim of the illness, because most people think there is very little good that comes from disease or disability.

    One of Bruce’s “comrades in ALS,” Pat Conway, has been living with ALS for six years. Pat’s wife, Kathy, says they have discovered many gifts in the progression of Pat’s disease, including the gift in accepting the disease and its impact. But, Kathy warns, acceptance is not to be confused with giving up. She says while it has not been...

    (pp. 59-64)

    The first installment of the Minnesota Public Radio series of conversations with Bruce was broadcast on the one-year anniversary of his diagnosis. In hindsight, that was probably too cruel a date to thrust him into the public spotlight when he and his family already had so many reminders of how life had changed in the twelve months since hearing that awful news. Now, a radio and Internet audience was privy to his pain.

    Some people might have fallen into a funk on such a somber anniversary, and to do so would be understandable. But later that evening, Bruce and his...

  14. 11 FAITH, PART II: It’s Your Choice
    (pp. 65-72)

    I’m still grieving the loss of my dad. Fritz Wurzer died on a bitterly cold morning in March 2014, just as the sun was coloring the sky pink and mauve and gold as it came up over Lake Superior.

    Dad always was a morning person.

    He was not, however, a person given to mourning. If my father had grieved the loss of his memory or his increasing inability to walk and talk, it was hard to discern. He was a stoic guy. I can count on one hand the times I ever saw him cry—grief for him was likely...

    (pp. 73-84)

    It may seem quaint and old-fashioned, but some of us still enjoy trying to find our destination using a road map—one made of paper and folded in that mysterious way that does not easily allow the user to refold it properly ever again.

    Some of the maps of the early 1900s were not, strictly speaking, maps of roads, since there were so few routes and not many cars. In 1901, the Automobile Blue Book Publishing Company printed detailed guides for pioneering motorists. AAA did, too, and there were others. Because there wasn’t a uniform road numbering system, and no...

    (pp. 85-89)

    One of Bruce’s favorite writers is Richard Powers. There is a line in his novelThe Time of Our Singingthat many of us who find ourselves buried under a growing heap of life’s commitments and complications can probably relate to: “Time is just one damned thing after another.” Beyond the exasperation and tinge of cynicism in that sentence, it is reflective of how many of us view time. We like to think time is linear: a sequence to be lived in, a minuteby-minute mode where the minutes add up to days, weeks, months, and years. The broader sequence is...

    (pp. 90-98)

    Bruce started doing inner time travel shortly after his diagnosis in 2010—but he’d logged hundreds of thousands of miles on nearly every kind of mode of transportation in the decades before. Bruce and Ev are enthusiastic world travelers. When they were in their mid to late twenties, they parlayed their wanderlust into teaching assignments in Norway, Egypt, and Thailand with plenty of exploration in a number of other countries before, during, and after those assignments. Travel for both was energizing.

    In the spring and summer of 2011, several months after his diagnosis, Bruce was walking with a cane. Stairs...

    (pp. 99-103)

    During the planning of this book each chapter received a working title and a summary of what it might contain. It was this chapter that scared me. Bruce thought that it would probably be the most raw of anything he wrote. The title alone made me nervous.

    I know very little about Buddhism. I did some prep on its basic tenets for the Nobel Peace Prize Conference keynote address that I moderated with His Holiness the Dalai Lama in Minneapolis in 2014. Buddhist teachings underscore that humans experience many different kinds of suffering; in fact, suffering is at the heart...

    (pp. 104-108)

    At first glance, any form of dis ease, from physical breakdown to crumbling marriage to job loss, would seem to be no laughing matter, but those who have traversed those challenges say the difficult uphill climb is made a lot easier with a little laughter. Humorous moments occur in any serious situation, and to notice and appreciate them are vital, or the sadness and frustration will crush your soul.

    My dad was a funny guy with a delightfully wacky sense of humor. His brand of funny was more Jerry Lewis than Louis C.K. Thankfully, he held on to much of...

  20. 17 READY TO FALL
    (pp. 109-116)

    One of the important milestones in a baby’s progression is when she takes her first wobbly steps. Gravity is a handy teacher, and falling many, many times is just part of learning how to walk, scraped knees included.

    As we get older, falling becomes more worrisome. The Centers for Disease Control and Prevention (CDC) reports that every year one in three adults over the age of sixty-five takes a fall resulting in injuries that range from a sprained ankle or wrist to a broken hip or worse, such as a traumatic brain injury. Bad falls, the CDC bluntly points out,...

    (pp. 117-122)

    Bruce is fond of saying that control is an illusion. We humans laughably think we’re in the driver’s seat, only to have some catastrophic event hit head-on, throwing us into a metaphorical ditch—a crumpled, diminished mess, dazed by the sudden absence of the control we thought we had.

    Even when there is evidence to the contrary, I persist in thinking that I’m in command of my life, and at times, I’ll admit (with all good intentions) that I try and control what’s happening with other people in my life!

    Bruce and I would often talk about my dad’s dementia...

    (pp. 123-130)

    Journalists have one of the most interesting jobs on the planet. We have a front-row seat to the show that is life in all its magnificence and horror, and our task is to chronicle it all, to help it make sense for everyone else. It shouldn’t be surprising that some journalists, in their final years, months, or days, have decided to report on their impending death from a terminal illness or their survival after a battle with disease. This kind of mortality journalism receives great public interest.

    I remember listening to a riveting commentary on the national feed ofMorning...

    (pp. 131-136)

    The granite grave marker nestled in the grass of section 2, lot 475B at Lakewood Cemetery in Minneapolis isn’t terribly fancy—and if the grass is overgrown, the inscription can be difficult to read. What surprises and then delights a visitor to the final resting place of Clyde Earl Hagen, who lies beneath, are the deceased’s wry last words: “My only regrets are the temptations I have successfully resisted.”

    Hagen was seventy-three years old when he died in 1974. His amusing epitaph reflects a soul who probably had quite a run in this world, and if we were to make...

    (pp. 137-143)

    A car’s windshield and its rearview mirror wouldn’t immediately seem like useful metaphors for life, but some motivational speakers and authors like the analogy. It goes like this. Notice how a car has a large windshield and a smaller rearview mirror. Of course the driver spends more time looking out the windshield at the road ahead. The rearview mirror is used to see what’s behind the car. Think now of your life. In the bookBecome a Better You,popular media minister Joel Osteen writes that “the implication is obvious . . . where you are going is much more...

  25. 22 FAITH, PART III: Wrestling with Angels
    (pp. 144-148)

    One of the most extraordinary things happened to Bruce on his fifty-eighth birthday. He received the gift of a lifetime, and he received it as he found himself wrestling with angels.

    Intrigued? You should be.

    First, about those angels.

    The vivid metaphor of wrestling with angels is from the Bible. Depending on the interpretations, it’s about Jacob’s struggle with a man, an angel, or God. It can also be understood as Jacob confronting his failures, weaknesses, and sins, and facing God. In the biblical story, Jacob wrestles all night with an angel and is wounded, but then asks the angel...

  26. 23 INSIDE OUT
    (pp. 149-153)

    Most of us face the world with well-worn armor, helmets pulled over our faces, ready to do battle. Others conceal with carefully crafted masks, wearing sadness like a heavy, musty velvet mantle. We humans tend to hide our real selves, wanting to protect the tender, soft, vulnerable parts of our essence. We project to the world the image we want to convey, not what is truly beneath the surface. There’s risk in allowing people to see the “real” you—risk of rejection and ridicule.

    We say and do the opposite of what we think and feel. In other words (as...

  27. 24 DIS EASE YOGA
    (pp. 154-160)

    Those who practice yoga say it is life changing. Those of us who are as flexible as a piece of lumber are not so sure. I admire yoga’s rich history, more than five thousand years old, but I run into a few mental roadblocks in understanding concepts like grounding and spinal energy. In fact, I was sitting in my slumped-over and crooked version of the lotus position during a special yoga class taught by Bruce’s mentor Matthew Sanford, when Matthew said to a student, “Breathe into your spine for God’s sake!” I had no idea what that meant. The student...

  28. 25 FAITH, PART IV: What’s Love Got to Do with It?
    (pp. 161-167)

    Kids who grew up in the 1940s, ’50s, and ’60s were not likely to hear the words “I love you” from their parents. Fathers of the time might have offered awkward hugs on occasion, but demonstrative displays of emotion were the exception, not the rule.

    Fritz Wurzer was one of those fathers.

    He came from stoic German stock. He signed birthday cards “Love, Dad,” but I can’t recall him saying, “I love you.” The closest he would come was to say, “Me too” if you were to utter those precious words to him. I write this with no anger, only...

    (pp. 168-174)

    Bruce is living—gloriously and fully, living as only one who knows his days are measured can live—with grace, great love, and sorrow over what is to come.

    The end of our time together is drawing close. I can feel it but don’t want to say that out loud. It’s childish to think that not talking about dying will somehow stave off the inevitable.

    We know how this ends.

    That knowledge tethered me to primal fears and petty worries, and had I given in to them, I would have missed the opportunity to bear witness to the brilliant conclusion...

    (pp. 175-178)
  31. Back Matter
    (pp. 179-180)