Normal Mortality

Look, this is how it works. You’re going to die one day. I know that’s kind of obvious but I just wanted to remind you in case you’d forgotten. You and everyone you know are going to be dead soon. And in the short amount of time between here and there, you have a limited amount of fucks to give. Very few, in fact. And if you go around giving a fuck about everything and everyone without conscious thought or choice – well, then you’re going to get fucked.

The Subtle Art of Not Giving a F*ck, Mark Manson

 

By declaring that man is responsible and must actualize the potential meaning of his life, I wish to stress that the true meaning of life is to be discovered in the world rather than within man or his own psyche, as though it were a closed system. I have termed this constitutive characteristic “the self-transcendence of human existence.” It denotes the fact that being human always points, and is directed, to something or someone, other than oneself – be it a meaning to fulfill or another human being to encounter. The more one forgets himself – by giving himself to a cause to serve or another person to love – the more human he is and the more he actualizes himself. What is called self-actualization is not an attainable aim at all, for the simple reason that the more one would strive for it, the more he would miss it. In other words, self-actualization is possible only as a side-effect of self-transcendence…Forces beyond your control can take away everything you possess except one thing, your freedom to choose how you will respond to the situation. You cannot control what happens to you in life, but you can always control what you will feel and do about what happens to you.

Man’s Search For Meaning, Viktor E. Frankl

Time stands still
Beauty in all she is
I will be brave
I will not let anything
Take away
What’s standing in front of me
Every breath,
Every hour has come to this

One step closer

A Thousand Years, Christina Perri

 

The other morning I was driving my daughter to school when the above song, A Thousand Years, played. It’s somehow one of those songs that five year-olds know already, despite never having been exposed to the Twilight series and vampires with existential issues and teenage girls with emerging personality disorders and werewolves with impulse control disorder. She asked me,

‘Daddy, is this what they sing before they’re going to die?’

I paused. ‘Before who dies?’

‘The people. Is this what the mummy sings so that her children know that they will be okay when she dies?’

It was said unassumingly, brightly even, without any hint of self-reference which I immediately became hyper-aware of. I stumbled to find an explanation which did not involve thousand year-old vampires and haematophagy.

Eva has completed her third week of five of daily radiotherapy. ‘It reduces the chance of systemic recurrence,’ the surgeon said. ‘Even though it’s a localised therapy, it seems to improve the prognosis.

Chance. Reduction. Prognosis. Risks. Imprecise, vague terms which had really been on the periphery of my horizon. There was an unquestioning acceptance of the medical and surgical teams’ assurance that they wanted Eva to grow old, to be annoyed at the surgeon in twenty years’ time that she had made him agree to chop both her boobs off. They say it earnestly and in a heartfelt manner; I know they are not lying. For what would be the point of saying, ‘you’ve got an X% chance of dying within five years. Fingers crossed you’re not in that group!’

As we’ve emerged into a more normal pattern of life – I have returned to full-time work, Eva is able to lift our hefty toddler and is not in pain from surgery or obtunded by chemo – we have started to think more of the future. Part of this was to start thinking about the months and years ahead. Eva and I had spoken about it to varying degrees, and she had always stated that she knew there was a chance of systemic recurrence of the cancer, but we had too many other things on our plate to think about the exact nature of this.

And then I came across a beautiful blog by Uzma Yunus, a psychiatrist in Illinois, USA, who talks about her breast cancer journey at Left Boob Gone Rogue. The first post I read made me laugh a lot, and sigh in recognition. But I was unnerved by her story; two young kids, also married to a psychiatrist (a tragic prognostic factor, apparently), and had been stage 3 oestrogen receptor positive breast cancer, who less than two years later after treatment was diagnosed with metastatic breast cancer. I had that sinking feeling which was present so often throughout those first couple of months after Eva was diagnosed.

Fuck. This could really happen.

But, as Uzma demonstrates, no matter what stage of a disease process one’s at, there is a life to be lived. There are children to love, other people to care for and to comfort, and to be loved by. She writes,

Cancer pushed me to find my path, it haunts me but I keep walking because now what I am doing is bringing me peace and joy. I make an effort every day to heal. Every day I make a choice to live some more. Life is as much about death as death is about life. They are related paradoxically and that is why I have more zest for life because I know that I will die. I see it up close and clearly every single day. To not die is to embrace life in present, to guard your thoughts and to hold on to peace within.

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Eva remains pragmatic, despite knowing very well the potential for relapse. We discussed our wish for her to be around until the kids are grown up. We hesitate about trusting in the ‘power of the mind’ to fulfill such wishes; there is such an attraction to grasp on to superstitions and wacky diets and anything that gives a sense of control in the face of a disease which feels like it is wrestling control away from you.

It has put things into greater perspective for us. I love Mark Manson’s book, The Subtle Art of Not Giving a F*ck. It is an antithesis to a lot of the pop and positive psychology that we are so exposed to (and for which there is some reasonable evidence, neveretheless). He highlights very well how the pursuit of happiness and ease can become a path upon which many stumble because Life. Can. Be. Really. Shit. He argues that, if we were more aware of impending death and our limited existence, we really would give a lot less fucks. As one of my senior colleagues puts it, we are all flotsam on the toilet of life waiting to be flushed. (We’ve warned him about saying that to patients.)

But, on the other hand, I’m also reading about Frankl’s experience in the concentration camps of the Second World War. He is honest and frank about his experience, the hardship, and the wavering sense of hopelessness which he felt and which he saw many others succumb to. He exhibits belief in an individuals’ ability through mentalisation and adopting an attitude of finding meaning in the apparent meaninglessness of the death camps, to become a survivor. He rated his chances of survival at 5%, but chose to find personal meaning in being a doctor and carer of other inmates, living with the daily risk of dying from typhus. He explores the numbness that he experienced in relation to the dead and the dying. He recounts not wanting to wake a comrade from a delirium-driven nightmare because what could be worse than waking up to the reality of actually being in a death camp?

In some ways Manson and Frankl seem to be at opposite ends of an existential spectrum: the former states that we should give no fucks, and the latter states that even when there was no apparent reason to give any fucks, the actual act of giving a fuck ‘(by giving himself to a cause to serve or another person to love’) enabled him and others to survive. I don’t want to misquote Manson, as he does argue that the fucks (okay, getting a bit tired of writing that now) we do give should not be in the pursuit of happiness; they should be given with ‘conscious thought or choice.’ And here I think Mark and Viktor are both on the money.

Pursuing happiness benefits us little. Investing in meaningful relationships and causes imbues us with meaning. As Frankl says, self-actualisation is all well and good (and it’s a pretty trendy subject in many circles, and has been for millennia), but it is only possible as a by-product of self-transcendence.

MEANWHILE, Christina is telling me that she’s loved me for a thousand years, which was not easy to explain to a five year-old, but I did rush out a garbled explanation of my Nana’s love, six years gone, still being present because it’s part of me, and that the love of people who have loved us, even if they die, still make us who we are today.

‘Oh, okay Daddy.’ Phew.

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So Christina’s also on the money. Mark and Viktor, too.

But for now, my wife grapples with this very real sense of mortality, and I grapple in close union with her. 75% five year-survival rate sounds pretty good, right? I mean, it’s better than 40%? But it’s 25% less than the rest of us non-cancerous lot. And Uzma is a beacon where, even if that relapse does eventuate, there is still life to be lived. Uzma, Christina, Mark, and Viktor.

Thank you, all four.

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Author: smenelaws

Husband, father, friend, vicarious cancer sufferer, doctor, amateur yogi.

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