Damu Smith looked handsome in his coffin.
His face, with its high cheekbones and sharp jaw, seemed full again. His hair had a soft sheen, having been freshly oiled and woven into small, braidlike twists by his beautician at the funeral home the night before. His unblemished skin was the brown of a honey graham cracker.
The women who loved him most sat on the wood pews at the front of Plymouth Congregational United Church of Christ, a few steps from where he lay. His sweetheart, Adeleke Foster, lovingly touched his face one last time. His sister, Sylnice Williams, dabbed at tears until her tissue was soaked. His 13-year-old daughter, Asha, stared blankly ahead with sad, dry eyes.
In his final days, as he underwent grueling chemotherapy, Smith said he was fighting for Asha -- "I've got to see the man she marries," he cried. But in the end, he was no match for colorectal cancer -- or his own failure to seek medical treatment.
Smith, 54, like many other black men, died before his time. Black men have a life expectancy of 69 years, six years less than white men and far shorter than men of other ethnic group. They are more than twice as likely to die from cancer as white men, according to the National Cancer Institute, and nine times as likely as white men to die of AIDS. They suffer from lung disease, heart disease, hypertension, stroke, diabetes and other chronic illnesses in disproportionate numbers that alarm health-care professionals.
"From cradle to grave, African Americans have the worst statistics in almost every area of health," said Khan Nedd, founder of the Grand Rapids African American Health Institute in Michigan.
At the funeral, Monique Harden of Louisiana lauded Smith's social activism, crediting him with stopping two major corporations from building chemical plants in historic black communities between Baton Rouge and New Orleans, a stretch of highway nicknamed "Cancer Alley" because of its high cancer mortality rate, possibly caused by emissions belching from chemical refineries there.
But Harden left an important anecdote out of her eulogy. One day in 2001, as she and Smith drove along Cancer Alley, he told her about stabbing pains in his stomach. Harden practically begged him to see a doctor. Smith politely brushed her off. "He told me I was right, said that he should do it, the way a person says 'Yeah, right, I should quit smoking,' " Harden recalled days after the funeral.
By the time Smith was tested -- four years after Harden's plea -- it was far too late. Colorectal cancer had developed to its most advanced and lethal stage. Doctors told him there was nothing they could do. They gave him three months to live.
In March, six weeks before his death, Smith had admitted that Harden was right. The pain in his stomach was almost certainly cancer, he said. He should have seen a doctor rather than attribute the cramps to stress.
"Stupid self-diagnosis," he said.
He made this critical self-evaluation seated in one of his favorite restaurants, La Tomate in Dupont Circle, with his elbows on the table near his favorite meal, spaghetti with marinara sauce.
Smith took only a bite or two. He could no longer easily digest food. He would suffer through the night. The day before, during a hospital visit, his doctor gave him grim news about his cancer. Tumors had spread from his colon to his liver and were moving toward his lungs.
Faced with this prognosis, Smith desperately wanted his death to matter as much as his life had. He sipped ginger tea in the low restaurant light and talked to a reporter who he allowed to chronicle the last weeks of his life. It would be his final activist effort. He wanted his story -- this story -- to serve as a cautionary tale, a warning to other black men to seek regular medical care: "Go to the doctor. Get your colon checked. Get a colonoscopy."
Smith knew this warning might be delivered from his grave.
* * *
The Father's Story Sylvester Smith was dying. Colorectal cancer had eaten away his 6-foot-5-inch, 250-pound body until he was practically skin and bone. His son Damu, who rushed home to St. Louis in 1981 to be with him during the last moments of his life, could hardly believe his eyes.
"Man, it was bad," Smith said. "He was in grueling pain."
Growing up in the tough Carr Square Village housing project, Smith idolized his father, one of the city's few black firefighters. At age 5, when Smith answered to his given name, Leroy Wesley, he organized a water-bucket brigade, scurrying around a neighborhood where drugs were sold and fights broke out between rival gangs, so that he could be a good Samaritan like his dad.
When Sylvester divorced Smith's mother, Vernice, father and son grew apart, but they still kept in touch, sharing conversations whenever they could.
On his deathbed, Sylvester was in constant agony, and full of regrets. He wished he had done more to prevent cancer. His diet wasn't as good as it should had been.
His son vowed that he would learn from his father's remorse. He refined his own strict diet, shunning red meat, poultry and dairy products. He embraced clean living, eating organic vegetables, drinking only filtered water. His holistic, vegetarian lifestyle became his health-care plan.
Here and there, acquaintances questioned whether Smith's diet and lifestyle were enough. Cancer is a killer that is known to stalk its victims through the family bloodline, hiding in DNA.
Gail Christopher, an acquaintance of Smith's, talked to him when they both won a free trip to a New Mexico health resort in 1994.
"I learned about his family history and his fear of disease," she said. "He was very afraid of dying, even then, of something horrible."
Smith felt that medicine and drugs were inferior to a carefully constructed diet using natural foods.
Christopher, who went on to become executive director of the Health Policy Institute at the Joint Center for Political and Economic Studies, admired Smith's devotion to pure living, but offered some friendly advice.
"You can't diet cancer away," she said.
* * *
Early Warnings In 2001, Smith felt a twinge of pain in his gut.
He ignored it. There was too much to do; there were too many injustices to fight.
He had been shuttling back and forth between Baton Rouge and New Orleans for almost 10 years. Often, he was so busy that he did not sleep. "I would drive down the road on the Louisiana coast at 3 in the morning, slapping the side of my face, blasting the radio, trying to stay awake," he recalled.
As an organizer for Greenpeace USA, Smith was responsible for rallying residents in Cancer Alley against the Japanese chemical company Shintech and Shell Oil Co. It was one of the few jobs he held that offered medical coverage. Smith could afford to see a doctor to check out the mysterious pains in his gut. But he didn't.
After Shintech and Shell abandoned their plans to build chemical plants, Smith became a premier black environmentalist. He left Greenpeace and founded the National Black Environmental Justice Network, linking black people to what was virtually an all-white movement. The move also meant he no longer had health insurance.
When the United States invaded Iraq, he started an antiwar group, Black Voices for Peace. He also hosted a talk show on WPFW public radio called "Spirit in Action."
As his stature grew, so did the stomach pains.
"They would come about every six weeks, but when they came, they really came," he said.
One day in Pittsburgh in 2003, as he prepared to deliver a speech to hundreds of people, the pains cut through his soul.
"I leaped up in the air," he said. "They kept coming. I had to act like nothing was happening."
Mindful of the disease that killed their father, Smith's younger brother, Leslie, got a colonoscopy in 2003. Doctors use the procedure to probe deep into the colon, searching for cancerous polyps. It was surprisingly painless, Leslie told his brother. You should get tested.
"He said it only takes you a few minutes, so go ahead and do it," Smith recalled. Once again he brushed off the advice.
"I did get my prostate checked," he said. "I did do that."
The prostate exam was a step forward, but it was a stutter-step.
* * *
'I Need to See a Doctor' By the beginning of 2005, Damu Smith's stomach was tied in knots. When he used the bathroom, he would bleed. He lost his appetite, shed pounds, noticed a reddish tint in his stool.
"I need to see a doctor," he said to himself in February. "Something's wrong."
He scheduled a colonoscopy at Providence Hospital. It cost $760, cash he didn't have.
But, Smith often found money to attend speeches and demonstrations, even those halfway around the world.
In March, he came up with enough money to send himself and a companion, the Rev. Carolyn Boyd, to Israel, where demonstrators planned to protest that nation's treatment of Palestinians. The colonoscopy, he thought, could wait.
"I said just let me go on this trip, and I'll handle it when I come back," Smith recalled.
He barely made the flight. He called Boyd on her cellphone as she sat on the plane at Reagan National Airport. His voice sounded weak on the other end of the line.
"I don't know if I'm going to make it."
But he did, stepping into the cabin at the very last minute, struggling to stand on his own. On the way to his seat, Smith leaned heavily on Boyd.
On a hot, dusty street in Bethlehem, Smith drifted away from the main group of protesters and slumped on a nearby car. The thud of his fall brought people scampering toward him, some praying loudly as he convulsed on the ground.
Smith might have died in the Holy Land if a nurse had not been in the protest group. She shoved candy and other sweets down his throat to raise his blood sugar as an ambulance roared toward them. The source of Smith's stomach pain was discovered by Palestinian doctors.
"They told me Damu had cancer of the rectum, cancer of the liver and cancer of the colon," Boyd said. "They couldn't bear to tell him. They told me to take him home."
Boyd kept quiet as well. She didn't know how to break that kind of news. She thought it would be better for her friend to hear it from doctors in the United States. Boyd relentlessly pressed Smith to get tested when they arrived in Washington.
Smith finally heard the news at Providence Hospital.
"You have Stage IV colon cancer," the examining doctor said. "It doesn't look good."
A second doctor chimed in.
"I know you didn't ask me," he said, "but people with your condition only have about three to six months to live. You should get your things in order. Don't sleep on this."
Smith gritted his teeth, curled himself into a ball on the hospital bed and asked to be alone.
"Why me?" he said in the silent hospital room.
* * *
Conventional and Holistic After his cancer diagnosis in April 2005, Smith embraced all forms of medical treatment.
"I'm now very clear," he said. "You have to use conventional medicine, too. You can't know what's lurking inside of you. I didn't make going to the doctor part of my lifestyle."
Psychologists, sociologists, health-care professionals and economists all proffer reasons why black men shun doctors. They lack insurance. They don't want to be seen as weak. Doctors are insensitive. Fear. Ignorance. Irresponsibility. Racism. Distrust of the medical system born of injustices such as the Tuskegee syphilis experiment, in which, to study the progression of the disease, doctors allowed it to grow untreated in mostly illiterate black sharecroppers between 1932 and 1972. In the end, 128 men died of the infection.
In addition to his reliance on his healthful diet, Smith indicated that fear was a factor. "I have to be honest with you, I used to think about going to get a checkup and I'd say to myself, 'I don't want to find out anything bad,' " he told a reporter for the Washington Afro-American three months after his diagnosis.
In his final weeks, Smith would not address the question head-on when anyone dared to ask. As he battled cancer, he did not want to dwell on past mistakes. He used the power of positive thinking to gracefully manage the pain.
But his inner eye wasn't blind. The past played over and over in his head. In a rare moment at La Tomate on a frosty night in March, about six weeks before he died, he shared some of his thoughts.
"It's not that I'm macho, or that I think I'm invincible," Smith said. "I actually thought that living the healthy lifestyle I was living, it would take care of me, help me through everything."
Smith recalled his conversation with Monique Harden in Louisiana five years earlier, almost word for word.
"Had I gone to the doctor when she said . . .," he started to say, but the sentence trailed off.
* * *
After 11 Months It was cold, white and sterile in the boxy examination room at Johns Hopkins Hospital where Smith sat, but he seemed oblivious to his surroundings.
He lifted his shirt and gingerly stroked the right side of his stomach, just under the ribs, the way a pregnant woman sweetly rubs her swollen belly.
"I can feel them," Smith said softly to himself. "I can feel them growing."
He was talking about the tumors.
It was now 11 months since his cancer diagnosis. He had undergone radiation treatments, chemotherapy, MRI scans and blood tests. Holistic doctors gave him vitamin shakes to drink and other forms of care.
His medical bills surpassed $400,000, an amount he couldn't hope to pay. Add more CAT scans, MRI images, blood tests, lab results, radiation and chemotherapy, and the cost could balloon even higher.
Smith had Medicaid, but that barely made a dent in what he owed. Friends held fundraisers in Washington and Atlanta that brought in about $70,000 -- not nearly enough.
Bill collectors were after him. One day in April, Smith answered the speakerphone in his Adams Morgan apartment and heard a voice yell on the other end of the line: "Sir, we need to talk to you! You need to resolve this . . ."
He coolly dropped the phone on the hook. "He doesn't have to talk to me that way," he said. Debt was the least of his problems.
Smith was still stroking his stomach when Wells A. Messersmith, his cancer specialist, strolled into the examination room around 3:30 p.m.
"How are you feeling, man?"
It was a rhetorical question. The patient did not look well. He had jaundice because of his failing liver. His eyes were as green as the meat of a lime. He weighed about 150 pounds, about eight pounds lighter than the previous week.
"I have a lot of pain in my abdomen," Smith said, holding up his shirt. "I have dry mouth." He was afraid to eat. "I know when I eat there is going to be so much pain and discomfort," he said.
There was good news, the doctor said. The chemotherapy was working. There were no more tumors in Smith's rectal area.
But other news was far worse. Smith was right about the tumors. They were growing and spreading. On the long drive home to Washington, he finally talked about the possibility of his death.
"I guess the point is that my life is in imminent danger," he said. "I can't play around. What's happening to me right now can kill me sooner rather than later."
Messersmith knew that death would likely come sooner.
"I feel sad knowing that this probably could have been prevented," he said in April, a week after his consultation with Smith, who waived his doctor-patient privilege so that Messersmith could talk about his cancer. "He really should have been screened at age 50."
* * *
A Daughter's Perspective Asha Moore Smith strutted into her father's bedroom and folded her teenage body into a narrow space between the bed and a window covered by thick, leafy houseplants. She kicked back in socked feet until they were almost parallel with her almond-shaped head. Using a remote, she flicked on the TV.
On popped one of her favorite cartoons, "The Grim Adventures of Billy and Mandy," a show about a little girl and boy who can force the Grim Reaper, complete with hooded robe and scythe, to be their personal servant, cleaning their bedrooms, washing dishes and performing funny magic tricks.
Her father lay on the fluffy double bed, face up, barely moving. Their trips to the park had stopped, and there were no more happy excursions to Disney World and Disneyland.
Asha, an eighth-grader, hardly seem to care, as long as she was near her dad. "My dad still does stuff with me," she said. "It's not like he has cancer and he doesn't do anything with me."
On the bed, he struggled to sit up, exhausted by both the illness and its treatment, which felt just as bad. Smith endured the pain without complaint, sometimes with a smile, but it was clear in those last days that his condition was worsening.
A circle was closing. Twenty-five years ago, Smith saw his father lying on a bed much like the one he was on. And now Asha was watching her father die.
Sometimes when they were together, she took stock of his illness with a child's curious mind.
"Daddy, your eyes are green," Asha would say.
"Daddy, I can see your cheeks."
"Daddy, I can see your ribs."
Smith and Asha's mother, Lynn Moore, thought long and hard about how to tell their only daughter that her father had cancer.
They decided to tell her the truth, leaving out the ugly details.
"As I recall, we were at the hospital, at Providence," Smith said, voice weak.
Asha lowered the sound of the television set.
"No," she said, "it was here." She looked at him with searching eyes. "Don't you remember?"
Asha was right.
Later, she tried to recall what Smith told her about the stages of cancer the way some kids try to recite the alphabet.
"There are five stages," she said, "and you were somewhere in the middle, at Stage III. That was not as bad. That is curable."
In reality, Smith was at the very top, Stage IV.
"I told her that people with Stage IV cancer live for years," Smith said. "It's not a death sentence."
What Asha wanted to know, he said, was 'Am I going to die soon?' " "I'm still here, right?" he said.
A short time later, Smith drifted off to sleep, and Asha turned up the sound on a cartoon where a little girl could boss death around.
* * *
In the End On a captivatingly pretty spring morning in May, Adeleke Foster arose at 7 and walked into the living room where her boyfriend slept. "Damu," she said softly. He did not stir. "Damu?" she said again, voice rising. "Damu!"
Foster called for an ambulance, and then she called one of Smith's closest friends, Sandy Rattley. Within minutes, dozens of Smith's friends heard the news and rushed to George Washington University Hospital, where doctors tried to revive him.
As he went in and out of consciousness, Smith groggily looked up at Asha, who had hustled to the hospital with her mom. She leaned her ear close to his whispering mouth. "I love you," he said. Minutes later, he faded into a coma.
A call went out all over the city, and by 8 p.m. the waiting room in the intensive-care ward was filled with friends and activists, about 30 people in all.
Dera Tompkins, who shared Smith's love for protest and reggae music, reminisced about the fundraising parties Smith threw. Milagros Phillips, who joined the "Spirit in Action" radio program as a co-host when Smith became sick, talked about how he soldiered on.
They lined the hallway outside Smith's room, going in one by one for a few private last words. Early on the morning of May 5, Smith took his final breath.
J.T. Lawson, a close friend, sped to Washington from Norfolk after hearing the news and arrived too late. He stepped into the room, grabbed a chair and sat near the bed where his friend lay.
"Damu, it's J.T. I know you can hear me," he said. "I'm sorry I'm late. I want you to know that I'm here. And I love you. And I will miss you."
Later, he reflected on Smith, their friendship and why he did not seek medical treatment.
"In black communities, Lawson said, "there's so much negative reinforcement when you tell someone you're going to see the doctor. No one says 'I'm glad you're taking care of yourself.' They say 'Are you okay?' 'Are you sick?' "God forbid you get a colonoscopy," Lawson said. "They ask 'Why you do that?' "
Another friend, Ayo Handi Kendi, a plain-spoken woman with sage eyes, stood in the hospital waiting room on that somber night.
"Damu was a wonderful man," Kendi said. "He was a very good leader," she said, one of the best she had ever seen. He was different because he truly cared for black people. He wanted to revolutionize their diets, turn them away from fatty foods.
Damu knew about the disparities in illness that afflict black men and worked against them. Which is why his death to her did not make sense.
"You know, we were a little upset with him for not seeing a doctor," Kendi said, keeping her voice low in the hospital waiting room. In a room full of friends and admirers, only Kendi volunteered a plain truth --though it pained her to say it.
"We thought he should have known better."