Ken Kirsh the Steelworker Pain Psychologist

Steven D. Passik, Ph.D., is a Pennsylvania-based pain psychologist. I’m proud to call him a friend. He is a giant in the field of pain medicine, but that doesn’t make his family and friends immune to suffering from terminal illness.

Steve lost his mother on September 14, 2016. Her story, The Painful Later Years of Frances Passik, appeared here. He’s given me permission to share the story of losing his best friend, Ken Krish,  here.

As it turned out, I had lied to my best friend.

When Ken Kirsh was first diagnosed with Stage IV colon cancer, I was only recently removed from my many years in oncology clinics working specifically with people suffering with his very disease. Resection of contained metastatic liver disease along with oxaliplatin, bevacizumab and irinotecan represented major steps forward in the treatment of the disease and had cured those who could undergo liver resection and extended the median survival to 22 months in those who couldn’t.  Ken was not a candidate for liver resection.

And so I told him, “Hey bro, things are moving quickly in the science of this disease and if you stay alive 2 years, something else will come along by then.”  I wasn’t lying at the time. I really believed it. Ken – I am not sure – ever did. I wrote about our complementary and opposite cognitive styles in a blog, There IS Crying in Baseball,  when he was first diagnosed, but did not mention our sometimes complementary and opposite emotional styles. Whereas, I am dispositionally optimistic, Ken was a dyed-in-the-wool pessimist.  He was the kind of pessimist that thought of himself as a realist and guys like me as self-deluded. Many times in our work together, his judgment saved us and helped us avoid disasters. Pessimists are good at anticipating problems.

My Best Friend’s Passing

And really good at preparation.  Ken died nearly 22 months exactly from his diagnosis. And when it came to the things that mattered to him and he wanted to complete, he was prepared.

All along, his main concern was the well-being of his loving wife Kristy and taking care of her after he was gone.  He worked right up to very near the end to make sure she would receive maximal support and together they paid off their mortgage in record time.  Throughout his life and in the 25 years I’d known him, I had always marveled about his clarity of purpose and consistency in his approach, always in the face of huge odds. Ken came by his pessimism honestly as one might if they wrestled with a neurological problem since birth. The last place in the world you want your baby pictures to appear are in neurology textbooks. And yet while that left Ken with the view that things don’t always work out for the better and that the world is indeed unfair, for people with pain he fought for fairness. When it came to devotion his was unmatched and to those lucky enough to get close to him he was easily one of the most generous of people you will ever meet. He was generous to me with, among a million other things, imparting his manner and temperament to our work – it toned down and took the edge off some of our pieces and made them more effective. Ken was insistent and resolute in his advocacy and far less abrasive than I can be.

Ken Confronts Cancer

Ken received FOLFOXIRI (folinic acid, 5-fluorouracil, oxaliplatin and irinotecan)-Bevacizumab a strategy that had changed from the days when they gave the oxali and iri parts separately when I was still in the field. As our dearly departed colleague in pain management, Dan Brookoff used to joke – and he was, by training, an oncologist – his colleagues were only happy when the chemo regimen name, composed of initials for the various agents, spelled out their wives’ maiden names.  It was extremely tough. Ken was tougher. He went through it, endured and showed up for work every day. Both of our fathers were blue collar workers – another thing that bonded us. Mine a railroad brakeman; his a steel worker. Ken, PhD and all, always approached work with an ethic and attitude of a steelworker. If he could have laced up work boots before crunching numbers, coming to clinic or giving a talk, he would have. Prior to his cancer, I don’t think I can ever recall him taking a sick day in 25 years. And he wasn’t, from the day he was born, a completely well guy.

After he progressed through this regimen he tried Erbitux. He initially responded and developed the telltale rash about which he joked about having teenage acne again. We joked about both of our turns as bass players in rock bands, playing in those earlier days of our lives. I was a bit of a hack (but as I told Ken, I could play fast), Ken was a serious musician and songwriter who played his whole life alone and with bands and along with the immensely talented Kristy on flute. Just another of his great talents and one of the things he shared during his younger years with his brother, Al, whom he idolized.

Later still Ken entered hospice.  During this time his friends visited and he welcomed them all though it was hard for him to interact in his usual ways. He was surrounded by his loving family, his mom and Al along with Ken and Kristy’s collies. And of course, Kristy was devoted to caring for him till the very end.

I saw my best friend the last time just a short time before he died. The cancer had taken a lot out of him. His usually lightning fast mind was slowed and his verbalizations even slower. We sat together for 2 days, often silent while he dozed or woke briefly to pick up the threads of a small talk conversation. I had made him cry when I told him how much more meaningful and important knowing him had made my life. I thanked him for always having my back no matter the controversy. I told him I would miss him every day. He cried, but couldn’t formulate too much more of a response and I decided not to go further through the quicksand saying all the “important” and “emotional” things for my own benefit  – things that truthfully, never required saying because our mutual respect and loyalty did not need explicit acknowledgement. I sat in a chair that was slightly behind where he was lying on a couch and it made me think of the million times I stood behind him when we were working, analyzing data or writing together and I would read what he was typing over his shoulder.  On my way back to the airport I was thinking how Ken is so woven into all my memories and thoughts about Lexington. I love that town and always will go back for Keeneland. Ken didn’t like gambling and only reluctantly came with me to Keeneland a couple of times. But I always saw him in the morning for breakfast and to work and after the track for dinner. My favorite place on earth won’t feel the same to me ever again.

His Goal: 100 Refereed Publications

I learned that Ken, one night not too long before he died, had expressed his wish to have made it to 100 refereed publications – he had 99. As if by magic, the next day, someone not privy to that conversation sent along a draft from a study we had all done asking for comments prior to submission. We all set about working feverishly to get it submitted while Ken could still appreciate it. Somewhere in heaven, I imagine Ken sitting around with our mutual dear friends, Si Budman, Howie Smith and Dan Brookoff and they are toasting him on his 100^th publication. Ken was always extremely proud of the work we did together; not just the volume but the quality. But 100 is a nice round number and Ken was exacting and liked round numbers. (the fact that the damn disease took him just 3 days shy of his 45^th birthday was thus all the more cruel – yet more evidence that Ken could be right about the basic unfairness of the universe).  Fortunately, I am fairly certain that with all his good works, Ken didn’t have to show his CV to get through the turnstiles at the Pearly Gates.

In his advocacy, Ken spoke truth to power and always put people with pain first. He showed it in the clinic and showed it in his research and writings. He was steadfast and reliably brilliant. He was unflinchingly honest and devoid of self-deception. You couldn’t help but love him. I loved him and now I miss him. I only wish science had marched on, cured him or given us more time with him and not made a liar out of me.

Originally published on Dr. Jeffrey Fudin’s site.

Purchase my book, The Painful Truth: What Chronic Pain Is Really Like and Why It Matters to Each of Us (available on Amazon), or read a free excerpt here.

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Copyright 2017, Lynn Webster, MD