Recalled to Life: Joseph’s Way Forward

How do you find peace when you know you are dying? That’s the question Joe Monninger, 71, has grappled with over the last three years. A resident of Warren, New Hampshire, he spends his time reading, writing, and enjoying time with his son Justin, and his partner Susan.

After 32 years as an English literature professor at Plymouth State University, Joe didn't expect Stage 4 lung cancer to be part of his life. He had spent decades traveling the world, teaching thousands of students, and publishing dozens of books and articles. Now, he planned to build a home to retire in on Maine’s coast—a dream escape for both himself and Susan—and looked forward to the challenge.

But after visiting the doctor for shortness of breath, he learned he had lung cancer. Just three days into his official retirement, he received the call. "It was a shock of shocks," he said.

Lung cancer is the leading cause of cancer-related deaths globally, according to the World Health Organization. There is currently no cure. Surgery would not be possible in Joe’s case, as the cancer had spread to other parts of his body.

“When you receive a diagnosis like this, it's perfectly natural to feel completely at sea,” Joe said. “Where are you going? What are you supposed to do?”

A line of support

“It was a very emotional few weeks and months,” said Justin Monninger. He and Susan are Joe’s primary support team, taking notes, asking questions, and accompanying Joe to his appointments.

Elliot Backer, MD, a pulmonologist at Dartmouth Cancer Center (DCC), was the first doctor to sit down with Joe and Susan and walk through his CT scan, showing them what was truly going on. This simple action was “something I admire to this day,” Joe said.

During the same appointment, Backer drained around 2,000 milliliters of fluid from Joe’s left lung— something Joe would eventually learn to do himself at home, or with the help of Justin or Susan.

Soon after, they would meet Konstantin Dragnev, MD, an oncologist at DCC. Dragnev is soft-spoken and serious, but with “a little bit of humor in his demeanor,” Joe said.

“While he has great empathy for you, he also is not going to baby you and not talk down to you,” Joe said. “He won my heart when he said: ‘From now on, I’m your doctor.’”

“He's worked incredibly well with Susan and me to make sure that we fully understand everything that's going on,” Justin said. It was around that time that Joe, Justin, and Susan learned that he could only have until Labor Day.

An unlikely match

One summer afternoon, Joe received a call with results from a blood test. Along with them were Dragnev’s new plans for treatment. “There’s no debate about this,” Joe recalls the oncologist saying. “This is what we’re going to do.”

In this call, Joe learned that he had a rare genetic mutation that made him eligible for a drug called Osimertinib that aims to slow cancer’s progress.

“It was an enormous thing,” he said. “I could take a pill and take my chances,” Joe said. He wouldn’t need chemotherapy or radiation.

Dragnev never gave a timeline, but he did give Joe something far more valuable—years he never thought he'd have thanks to his precise identification of the genetic match with the drug.

In three years, Joe had traveled, gone fly-fishing, published a memoir, and told his story.

“Suddenly, I was recalled to life,” he said.

The biggest challenge, Joe said, has been not knowing how long he has left. That’s something Dragnev has not been able to tell him. “It’s like going on a camping trip. Are you going to go for three days or two months?” he said.

“He gave us quantifiable data,” Justin said. “[He said] we're going to make actionable decisions as new data comes in as we continue to watch you and work with you.”

Days with low appetite, feeling short of breath, and having low energy are Joe’s reminders that he is living with cancer. Other times, he feels good enough to forget it’s even there.

“Getting a diagnosis like this, everything in your world changes,” he said. “And at the same time, nothing changes.”

Every few months he goes for check-ups and a bone density shot at Dartmouth Cancer Center.

At the same time, he still makes breakfast, does laundry, and plays cards on the deck with Justin and Susan. He also looks back on days spent in a stream or in a pond, doing the activity he loves dearly: fly-fishing.

Where time stands still

Joe has set foot in rivers and ponds around the world in pursuit of fish, serenity, and fun. These days, he is not able to fly-fish like he used to. But it played an important part in his life for decades.

“Fly-fishing is the only thing I do that's the only thing I do. Meaning, I don’t think of anything else,” he said. Fully immersed and in a meditative state, in a river or a bog, he’s enveloped by the landscapes and loses his sense of time.

“We like to laugh a lot,” Justin said. “But we also know when it's time to be quiet and separate and catch some fish, and really appreciate where we are.”

There are great moments in fly-fishing, especially when you least expect them. The same could be said about his diagnosis, and learning about Osimertinib.

Books like The Emperor of All Maladies, Being Mortal, and How We Die have helped Joe wrestle with his own mortality. As did writing his own memoir.

Already a published author of more than 30 books, Goodbye to Clocks Ticking: How We Live while Dying published in 2023 would be his last.

In it, he shares his experience and mindset in more detail. “One thing I would say is there's peace inside this. There's a way to be peaceful about it,” Joe said.

“For others facing a similar journey, remember to keep laughing,” Joe said. “Recognize what you have that’s right in front of you. If you’re feeling diminished, find ways to give,” he said. Susan tells him that, too.

“There are people who have a difficult life,” Joe said. “They’ve never even had the good days that I’ve had. So, in that way, I’m lucky.”