The sun has just risen at the Kissack ranch in Wyoming and Nathan, 31, is drinking coffee out of a big John Wayne mug.
As he takes a few sips, a famous John Wayne saying appears a little below the rim on the inside of the mug: “Courage is being scared to death, but saddling up anyway.”
The quote perfectly sums up the last year of Nathan’s life.
Last July, blood cancer hit the young man out of the blue, just when he was back home working with his parents on their cattle ranch. There was no history of the disease in his family. And, Nathan had been in the best shape of his life as he trained to climb the highest peak in South America, Aconcagua.
Then, he was pretty sure he was dying.
Nathan had to gather up his courage and saddle up day after day: first at the hospital in Gillette near his home when one of his lungs collapsed, then as he endured dozens of chemotherapy treatments over 100 days at UCHealth University of Colorado Hospital, where he was transferred. The hospital on the Anschutz Medical Campus is one of only a handful of places in the Rocky Mountain region where Nathan could get treatments for his rare type of blood cancer: T-cell lymphoblastic lymphoma.
There were dark times. One week, the brutal cocktail of medications he needed was especially bad and he suffered torturous headaches. All Nathan could do was darken the blinds in his room, ignore his phone and listen to ESPN in the background, in hopes of finding a little distraction.
There were wonderful moments too. Someone dropped off an unsigned card at the Kissacks’ house in Wyoming. It had 10 $100 bills tucked inside of a note thanking the family for always having been so kind to others. Friends and family rushed to Nathan’s side. They made posters and sent photos and cards that he hung on the walls of his room. Nathan long had had a crush on one friend named Julia Popish.
Julia was finishing up her rotations for a demanding veterinary degree in Fort Collins at Colorado State University. Still, she found time again and again to visit her friend.
“That first night, she crawled into the hospital bed with me, which was way nice. You’re just so scared and pretty alone at night with your own thoughts,” Nathan said. “She was crazy busy, but she came and saw me more than 10 times.”
To keep himself going during the worst times, Nathan thought about getting back home to the ranch and climbing mountains again.
He also looked forward to every visit from Julia.
“I had liked her for such a long time, but timing was never our thing. She had a boyfriend and I had a girlfriend when we first met,” Nathan said.
“But, if you’re going to get cancer, you might as well use it as a wingman,” Nathan says with a big grin.
Back home on the ranch
What a difference a year makes.
On a warm fall afternoon, Nathan is literally saddling up. He and his folks, Bart and Kathy Kissack, need to move over 100 head of cattle to a pasture with fresh grass. It’s been a remarkable summer, complete with unprecedented rains. The pond on this part of the ranch is brimming with water, creating a haven for birds. The cows are good and fat. Some would be just as happy staying right where they are, thank you very much. But it’s time to move them to a new pasture.
You city slickers no doubt have heard the line from the old cowboy song, “Git along little dogies.” That’s Nathan’s job on this cattle drive: to keep the little calves, born in the spring, moving along with their mamas and the others.
Nathan looks perfectly at home back in the saddle and back home in Wyoming. He’s riding a gentle, 18-year-old quarter horse named Dixie, while his mom and dad, each riding four-wheelers, speed ahead to open gates and work the sides, keeping the cattle together and moving.
Waist-high prairie grass waves in the breeze. Tall trees are rare here. They stand sentinel over ranch houses and otherwise, this is the land of wide-open vistas with far more antelope than people. Nearby, perfectly pointy buttes rise up every so often. They look like a preschooler’s drawing of mountains, evenly spaced and not too tall.
Nathan is in his element.
“I get to work with my dad every day,” he says.
Later, his dad’s eyes tear up as he gazes at his son proudly.
Nathan enjoys driving cattle, mending fences and “doctoring” cattle when they’re sick. In particular, he loves calving season from February through April, even though it means tending to pregnant cows in temperatures that can plunge to 30 below. Night after night, he loses sleep, but gets to witness quiet miracles.
“I love bringing a new life into the world,” Nathan said. “The heifers, the first-time mamas, are the toughest. They’ll get confused sometimes and can kill their own calves.”
When the cows are close to delivering, Nathan and his folks bring them into the barn overnight. An untended newborn calf could die in minutes in the harsh Wyoming weather.
If a cow is having trouble birthing her calf, Nathan sometimes pulls the little one out and puts the calf in a warmer. And, if a cow isn’t letting her calf suckle right away, Nathan uses a tube feeder to put milk straight into the hungry calf’s belly.
A rancher’s grit
Nathan enjoys nursing animals. Needing to be nursed himself was a whole different matter.
He had been haying with his dad last summer when he decided to see a chiropractor buddy about pain in his back. He figured he had just strained it while doing the manual labor that is part of every day life on the ranch.
The news was bad. An X-ray showed a large tumor right in the middle of Nathan’s chest. The friend sent him straight to the ER. Doctors in Gillette knew Nathan had cancer, but weren’t sure at first which kind.
Within days, Nathan’s lung had collapsed and he had clots in his lungs and left arm. His body swelled with fluid. The quick decline was scary and shocking. Nathan’s doctors consulted with experts at UCHealth and transferred him to University of Colorado Hospital.
That’s when Nathan learned he had a relatively rare type of blood cancer that often strikes children and younger adults. Doctors don’t know exactly what causes T-cell lymphoblastic lymphoma. And, while experts have made dramatic gains in treating some types of blood cancer, they don’t have any new treatment options for Nathan’s type: just heavy doses of chemotherapy.
Even so, Nathan’s age, fitness and fierce determination proved powerful.
“Since he’s young and physically fit, we could use the toughest chemotherapy regimen for him,” said Dr. Bradley Haverkos, Nathan’s cancer specialist and an assistant professor at the University of Colorado School of Medicine. “When older people get this cancer, the prospects are much worse because they can’t get the same chemotherapy.”
Nathan initially tolerated the intense regimen well. It got harder later, which Haverkos said is typical.
“The cumulative effects of the chemotherapy can build up and wear you down,” Haverkos said.
Midway through Nathan’s hospital stay, doctors were able to give him the great news that his cancer already had disappeared. There had only been a 50/50 chance of trouncing it so fast, but Nathan got the best possible results.
“There are no signs of cancer anywhere,” said Haverkos, adding that long-term remission is a good possibility.
Danielle McAvoy was one of Nathan’s nurses. She met him the day he arrived in Aurora. His dark brown hair hung well below his shoulders. In the winter, along with long hair, he wore a full, thick beard to stay warmer on the ranch. But Nathan knew the chemotherapy he needed was going to rob him of all his hair. So, he asked McAvoy for shears and enlisted his mom to cut off all his hair and donate it to a nonprofit called Wigs for Kids.
Nathan said he’s a “rip the Band-aid off “ kind of person. During his treatment, he had to endure 10 spinal taps. Instead of delaying them, he had the nurses get them over with as soon as possible.
“Yeah, that grit comes from ranching,” he said.
McAvoy supported Nathan through the worst of times. Despite the hardships and humiliations – like having company in the bathroom when he was at risk of falling – McAvoy said Nathan kept everyone on his hospital floor entertained.
“He had the best attitude of anyone I’ve ever seen and it made such a difference,” she said. “He had a really great support system, which is crucial for all of our patients.”
Nathan deliberately avoided reading online about blood cancer so he wouldn’t spook himself. Instead, he focused on the future and chatted his nurses’ ears off about Julia.
“He was absolutely smitten and it was adorable,” McAvoy said.
Lessons in perspective
Along with crushing on Julia, Nathan frequently thought about escaping his hospital room and getting back outside.
On the ranch, he’s out in the elements all the time. Some of the work isn’t any fun. Haying, in particular, gets monotonous. But, he loves being outside on quiet mornings. In good weather, the meadowlarks are singing. Or, Nathan tunes in to podcasts or some of his favorite music. Years ago, he was in a hardcore band. But, he also loves country music.
On rare days off, Nathan has been getting more and more into mountain climbing.
In June of 2018, weeks before his cancer diagnosis, Nathan and a buddy had climbed Cloud Peak. It’s a rigorous, 12-mile one-way journey to the summit of Wyoming’s fourth tallest peak.
And, that’s if you do it the easy way. Nathan and his friend, Clark Van Hosier, inadvertently did it the hard way.
“We were lost and cold and frustrated. We had no snowshoes and were post-holing into snow up to our thighs. It hailed on us three times,” Nathan said.
Still, they made it. With detours, Nathan figures they did about 30 miles altogether. The view from the summit down to ice blue, glacier-fed lakes was incredible.
The trip also gave Nathan one of the great lessons he has learned over the past year: perspective.
As he told Clark, “No matter what happens, I don’t think anything is ever going to be that hard again.”
Well, think again. He had no idea that cancer was lurking around the corner and that the treatments would be brutal at times. Still, on his worst days, Nathan thought about going back to Cloud Peak and perhaps someday climbing the world’s tallest peaks like Aconcagua in Argentina and Kilimanjaro in Africa.
Reaching the summit again
Nathan finally got to leave the hospital at the end of October, exactly 100 days after he arrived. McAvoy and other providers on the blood cancer unit gave Nathan a special sendoff, linking their hands high in the air and creating a tunnel for him to triumphantly pass through – just like parents do for little kids at soccer games.
While Nathan’s prognosis is excellent, he still needed intensive chemotherapy through April. He could do that in Gillette for five days every three weeks. Over the long term, he’ll need easier rounds of chemo once a month for at least two more years.
Even with all those chemo treatments, Nathan was feeling well enough by summer to set his sights on Cloud Peak again. He planned the trip for mid-July, on the anniversary of his cancer diagnosis. His friend, Clark, came along again as did another friend, Whitney Gunderson.
“This time, we were going to do it right,” Nathan said. “We had more food. It was way warmer.”
On the morning when they planned to hike to the summit, Nathan and his friends put on headlamps and headed out from their camp at 4 a.m. They wanted to make it to the top by 10 a.m., before the thunderstorms rolled in. Nathan’s friends put him in the lead so he could set the pace. His dog, Nightlinger, who is named after a character in a John Wayne movie, walked by Nathan’s side.
Just before Nathan reached the summit, Whitney looked up and saw her friend on a beautiful rocky outcropping with the sun rising behind him and Nightlinger at his side. She snapped a photo that encapsulated Nathan’s joy in being able to climb again so soon after his cancer struggles.
“It felt so good. It was really rewarding. Then, we went back to Buffalo (Wyo.) and had three cheeseburgers and a beer,” Nathan said.
Back when he had been in the hospital, Nathan’s mom remembered doctors and nurses telling her son that he would soon be climbing mountains again.
“He was going through all these complications, and in the back of my mind, I was thinking, ‘don’t give him false hopes,’” Kathy Kissack said.
But sure enough, Nathan’s team had been right.
His mom watched proudly as her son battled back.
“I really admired his grit and determination,” she said.
Nathan impressed his doctors too.
“He’s so ambitious and he’s out there living life,” Haverkos said. “That’s part of the reason he’s done as well as he has. Not everyone gets through all the chemo and climbs mountains. He’s gotten back to his life pretty quickly. He’s definitely a model.”
‘As long as I felt I was needed, I settled in’
Gradually, as Nathan recovered, he started to feel like himself again. He had made it back to Wyoming. He had climbed Cloud Peak.
He and Julia remained friends and kept getting closer during marathon Facetime sessions.
One of Nathan’s goals was to get fit, both so he could feel healthy again, and so he could impress Julia the next time he saw her.
Months in bed had robbed him of his muscle tone, then steroids had sent his weight ricocheting all over the place, up to about 189 at one point from his regular 155.
Every morning, when he felt well enough, Nathan got up at 4:30 and met buddies in Gillette when the gym doors opened at 5 a.m. so he could work out before working on the ranch.
When his immunities were down due to courses of chemo, he wore a mask and still worked out hard. One day, he pushed himself too much and passed out. Another time, he dropped a barbell on his face. Neither incident stopped him. Nathan just assigned friends to keep an eye on him in case he got woozy and fainted again.
Julia, meanwhile, had graduated from vet school and was considering job offers far from Wyoming. She’s originally from Casper and had met Nathan when she was tending bar at a restaurant in Laramie. Each was dating someone else at the time, but they kept in touch and a strong friendship developed.
“He was just this hilarious character with long hair and zero filter. We had a similar sense of humor,” she said.
They hadn’t talked for a couple of months when Nathan called Julia last year.
“Hey doc, why don’t you give me a call,” he said on a message, using one of his favorite nicknames for her.
Cancer scares some people. Julia didn’t flinch. She’s the daughter and granddaughter of veterinarians. Medical challenges for furry patients had been part of her life every day. She was used to being a rock for friends. And, coincidentally, when Nathan was going through his health ordeal, Julia happened to be doing oncology rounds. It turns out that there are similarities between cancer in dogs and cancer in people. What’s more, empathy seems to come naturally to medical pros who care for animals.
“Our patients can’t tell us what’s going on with them,” Julia said. “And my education had exposed me to emotionally taxing situations.”
Visiting Nathan in the hospital helped Julia get away from the hard work at school. She showed up, crawled into his hospital bed and brought lighthearted banter with her.
While Nathan was crushing hard on her, Julia was still in friend mode. She gave him a break from talking about cancer, while privately researching his illness and encouraging him to ask important questions.
“As long as I felt needed, I settled in,” she said. “I didn’t expect us to become more than good friends. It was all silly and goofy.”
Then the summer rolled around. Back when Nathan was in the hospital, he leaned on Julia.
“It was a human connection in its purest form,” Julia said.
Then, after graduation, Julia moved to San Diego to start her first job in early July. Suddenly, the tables had turned and Julia found herself leaning more on Nathan. She was in a new city, with a new job and knew almost no one in California.
Nathan wanted to be one of her first Wyoming friends to visit.
‘Maybe cancer’s been good for you’
Nathan’s hair was starting to grow back. He was getting eyebrows and facial hair again. And he was posting photos of his buff body on Instagram.
Julia, meanwhile, was starting to think of her friend in a new light.
“I finally took a step back from the relationship and looked at what I would want in a partner: someone you could go through the ups and downs of life with and still manage to have a sense of humor,” she said. “The dude broke me down with all these compliments over three years.”
Maybe their timing was about to be perfect for a change.
Nathan has two younger brothers, Jake and Levi. After the worst of the cancer ordeal, Levi said something funny, but true: “Maybe cancer’s been good for you.”
Nathan immediately agreed.
“I was pretty flippant with things before. It took me a long time to grow up. I always had to learn the hard way,” Nathan said.
Meanwhile, Nathan and Julia started discussing a change in their relationship.
“Before cancer, Nathan had a crush,” Julia said. “Cancer basically erased that relationship and a new, raw authentic connection developed, from which something more could grow.”
Now, Nathan was ready to travel several hundred miles and speak his mind. Julia, in turn, was ready to give their romance a shot.
He flew to San Diego in August to celebrate Julia’s 27th birthday with her in person. The year before, he’d had to make due with a call from the hospital.
Nathan’s flight landed around 5:30 p.m. He thought Julia would be working and that he’d meet her later at her apartment. But, things were looking up when she met him at the airport.
“She picked me up. She fooled me,” he said.
Nathan didn’t arrive with any grand gestures. He just spoke from the heart.
“I told her that she’s really cool and I wanted to take it seriously.”
Julia agreed. And they went on to have a wonderful official first date, enjoying tacos, then live music at a punk club. Julia wore one of Nathan’s tee shirts from a favorite band: As I Lay Dying. The gesture was sweet. And there was a bonus. Nathan wasn’t laying in a hospital feeling like he was dying anymore.
The next day over coffee, Julia and Nathan reveled in the normalcy of their relationship. Yes, in a way, everything had changed. But, in reality nothing had. They were still very good friends, who could laugh and talk and be 100% real with one another.
“Sometimes, you’re the dating version of yourself,” said Julia. “I’d rather have a best friend, then move into a relationship.”
Some of her friends wondered if she was afraid to date someone who had coped with cancer.
Nah, she told them.
“We already went through the worst parts,” she said. “If anything else ever happens, we’ll just be that much more prepared to handle it.”
Adds Nathan: “I don’t have a lot of fear with anything now. My biggest fear now is regret.”
And so, with Julia’s help, Nathan got a new tattoo to go with his many others, including one of John Wayne on his left foot.
Julia designed the new one. It’s an image of a mountain with the simple, powerful message: victors not victims.
“I’m always working toward beating this and not being a victim,” Nathan said. “Everything gets exponentially easier after cancer.”
Plus, he and Julia are planning a future together.
“It’s super weird,” he says with huge grin. “I’m like a dog who caught my tail.”