He's clawed his way to the other side after a yearlong struggle with a particularly aggressive prostate cancer. His body is riddled with scar tissue. He has lost about half his hearing. His treatment is putting him through a sort of male menopause.
He was supposed to be dead by now.
The turnaround came late last year after Hawker, an influential state representative, sought a second opinion from a doctor at the Mayo Clinic. His new doctor offered a new course of treatment: Quit the chemo and starve the cancer with hormone deprivation therapy.
In January, a month into the treatment and just as the legislative session got under way, Hawker was making dramatic improvement. But no one was sure whether that was a blip or whether he was really beating back cancer.
It had metastasized throughout his body when it was discovered last summer. It was in his lymph nodes. A femur. His backbone. His pelvic bone. His bladder.
Six months later, Hawker says the cancer is nearly gone.
"My body inside looks like a battlefield," Hawker said recently. "I had cancer everywhere. And it's now all died. It's a bunch of scar tissue in there."
The good news came after a series of full body scans in May at the Mayo, in Rochester, Minn.
All they could find is "one little glowing ember of it left in my pelvis bone."
Now he wants to share what he's been through in the hope someone else may benefit. Many men get prostate cancer but it usually is slow-growing. As Hawker says, men usually die with it, not from it.
Yet the fierce type is prevalent enough to be the second-leading cause of cancer death among men in this country, after lung cancer. And Hawker is not out of the woods. He'll be fighting the disease the rest of his life.
Hawker has a message for people with a dire prognosis: Get a second opinion.
FRESH LOOK AT HEALTH CARE
Hawker, a Republican first elected in 2002, was the Legislature's chief architect of the state health and social services budget for years. He spent two legislative sessions as co-chairman of the powerful House Finance Committee.
In November, he was so sick he left that House leadership post and was given a less strenuous role as chairman of the Legislative Budget and Audit Committee instead. In one unforeseen consequence of the switch, Republican Reps. Kyle Johansen and Charisse Millett walked out of the GOP-led caucus, upset that she didn't get that chairmanship.
Hawker's cancer odyssey hasn't led to any big revelations. He says he liked his life before last summer's grim diagnosis. He didn't make a list of things to do before he died. He'd already traveled the world. He already has a BMW.
His political views haven't changed, either. But he says he's recharged for the public policy job he loves and is giving new thought to health care issues.
Hawker says health care -- all aspects, from cost, to access, to aspects like treatment for substance abuse -- is the second biggest issue facing Alaska, behind declining oil production.
He has double insurance coverage, through the state as a legislator and through his wife of 13 years, Carol Carlson, a senior financial analyst at Conoco Phillips. It's a first marriage for both. They were in their 40s when they married and they have no children.
So far, the medical billings total about $400,000, though insurance companies adjust the bills down, Carlson said. They've paid about $10,000 themselves. A single shot that accompanied each round of chemotherapy was billed at nearly $11,000.
Does Hawker support universal access to care?
Not if it means a government-run system, he said.
He said he doesn't have a big-picture solution. Some targeted fixes are happening without government mandates. With backing from Hawker and other key Republicans, a retired cardiologist opened an Anchorage Medicare clinic to serve patients who have had trouble getting a primary care doctor in Anchorage. Startup money came from the state.
Doctors who aren't part of "the medical establishment" often find better ways to treat patients, Hawker said
The doctor treating his cancer, Eugene D. Kwon, is a urologist at a small clinic within the Mayo system. Kwon, also a professor of urology and immunology at Mayo, specializes in cases of advanced prostate cancer. He is researching treatments that provoke patients' own immune systems.
Hawker calls him "The Mighty Kwon."
THE BAD NEWS
In the summer of 2010, Hawker went in for what he thought would be a routine annual exam addressing blood pressure, cholesterol, exercise -- the usual things men in their 50s are supposed to talk about with their doctor.
Past screenings for a marker that could indicate the presence of prostate cancer indicated low levels: 1, 2, 3. This checkup found trouble. Now his prostate-specific antigen, or PSA, had shot up to 45.
Further tests confirmed he had cancer and it had erupted throughout his body.
One of the tumors had obstructed the tubes connecting his kidneys to his bladder. Doctors told him he was within weeks of total renal failure. He had surgery to temporarily bypass his bladder.
His Anchorage oncologist said he didn't have classic prostate cancer, but diagnosed him as having small-cell neuroendocrine cancer. Samples sent to Johns Hopkins Hospital in Baltimore confirmed the diagnosis.
He was put on an intense chemotherapy regime. Chemo one week, life in a fog the next, recovery the third. He slept in a recliner in his house and was too sick to even check in with his legislative staff many days.
The chemo didn't knock down the cancer. Just before the November election, he was told he'd need around-the-clock care by March and probably had six months to live. He felt cheated out of the last third of his life. His parents are both still living.
Only a few people knew how bad it was: his wife; House Speaker Mike Chenault; his legislative staff.
"We are asking our doctors here, what else can we be doing?" his wife, Carlson, said. "The doctors are telling us there isn't anything else."
Carlson didn't buy it. She researched options on the Internet and made countless phone calls. "I'm going to give him his fighting chance," she said.
A couple of the leading cancer centers Outside said they'd see him. At least one told her there was nothing they could do.
She stumbled on a research paper that Dr. Kwon had written. She got him on the phone. He thought he could help.
In early December, Hawker and Carlson went to Mayo. Hawker was so sick he had little hope.
"I never expected to see Alaska again," he said.
THE GOOD NEWS
Hawker's cancer was very advanced, said Kwon, who spoke on the phone with Hawker's permission.
"It's safe to say he was dying," Kwon said. "He wasn't wheelchair-bound and he didn't come in on a stretcher but he was close."
The standard treatment for prostate cancer that has spread to other parts of the body is not chemotherapy like Hawker had been getting, but hormone deprivation therapy, which cuts off the testosterone that feeds the cancer, Kwon said.
Many doctors believe that his type of cancer won't respond to hormone therapy. But Kwon said you don't know until you try the treatment and it fails.
Some cancer cells die outright. Some go into hibernation, like a weed cut off from water. Some seem to have a built-in resistance and don't mind the loss of testosterone.
Hawker had a fast, remarkable response, Kwon said.
But: "The reality is with every one of my patients I always tell them, there's no such thing as curing anything. There's no such thing as eliminating all the cells," Kwon said.
The best they can do is make the cancer irrelevant.
Maybe Hawker will be a candidate for new treatments, including the immune system therapy Kwon is researching in clinical trials.
Hormone treatment is not without side effects.
"I'm a 55-year-old male going through menopause," Hawker said. "It means I have all of the classic symptoms of menopause. Everything from the hot flashes, irritability, night sweats. Weight challenges. Potential moodiness."
He gets a monthly shot and takes a pill twice a day. Sweet little things can make him cry.
"Watching the day break out my window in the capital overlooking the channel," he wrote in an email. "A foggy day, the kind that wraps itself around you like a comfortable old coat. My staff throwing a little office celebration when I lived to the end of regular session despite what we had been told by the doctors."
He says he never had a meltdown during the legislative session, but his staff kept him away from the action right after he took one of his regular shots.
He was weaker than most people knew. In Juneau, he still had tubes connected to his kidneys and bags outside his body to hold urine. He was feeling the chemo effects. He had lost his hair, part of his hearing, and sensation in his fingers and feet.
He says his wife saved his life, and his staff healed him. One aide, Rena Delbridge, got him walking up the Capitol stairs. He remembers how happy he was taking notes in a committee hearing and being able to read what he wrote.
He plans to run again in 2012. He's looking at the world with the view of a much younger man.
"As we age, we tend to settle into routines that are essentially lives of quiet decline," Hawker said. "I find a burning intensity now. Living every single day is a much more intense experience than it ever was before."
Reach Lisa Demer at ldemer@adn.com or 257-4390.
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