A few years later, for the first time, Larry missed his appointment with me. I knew that something must be terribly wrong when I failed to see him holding court in the waiting area 30 minutes before his appointment. I tried calling his home phone, but the line was constantly busy. About an hour later, I received a call from his mother, who told me that she’d found Larry dead in his bed. An autopsy was not performed, so I can only guess that Larry died of a cardiovascular event.
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What did I learn from Larry? Perhaps the most important lesson was to follow the sage advice of his favorite philosopher, the baseball legend Casey Stengel, who once decreed: “Never make predictions, especially about the future.” This was Larry’s credo; he always lived life to the fullest. Never mind that he faced a life-threatening cardiac tamponade, or that a few years later he would be told that lupus nephritis would eventually destroy his kidneys and lead him to the dialysis unit. And that, for twenty years, somehow he kept walking on a pair of totally worn out hips that should have been replaced a decade earlier. And how he only could see half of his visual fields. Nothing fazed Larry. Was it a strong sense of denial? Maybe. But I always knew that he understood the serious nature of his disease. He just wanted to imagine a better outcome. He once confided that he used positive imagery as a way to create a world where he could live his life as though he had no illness.
Larry was not a therapeutic nihilist. He would have only partially agreed with the patient–author of Anatomy of an Illness, Norman Cousens, who once said that, “drugs are not always necessary, [but] belief in recovery always is.” Larry recognized his need for treatment. Yes, be optimistic, but don’t leave everything to chance. When I look back at Larry’s treatment and compare it to what we would have offered him today, there is literally no difference: steroids, azathioprine, hydroxychloroquine, cyclophosphamide. Sadly, not much has changed over the past 40 years of lupus therapeutics. Yes, we are better at treating the infectious complications that sicken our lupus patients and maybe we are improving the management of their cardiovascular risks. But we owe it to Larry to do a far better job at taming the lupus beast.