Saturday, August 8, 2009

Courageously battling X

Scanning the obituaries in the local paper today, I soon came across the person who had died "after a long, courageous battle with leukemia." I wondered just what that meant. I decided it meant she didn't make other people uncomfortably aware of her pain and fear. She didn't cry much in front of other people, she didn't whine, she smiled, she put on a pink turban and went to parties and tried every kind of chemo, proven or not. Effort. I mean, what the hell does it mean to "courageously" "battle" the inevitable? Can you battle in a cowardly way? Or can you just battle, without any adjectives? Or can you not battle at all, and can that be a dignified choice?

Going down to the basic assumption, that battling is good, I wonder whether this is a distinctly American thing, part of the dream of conquering all frontiers through sheer force of will (i.e., doing violence to the Other)? I could, in my mind, imagine someone in a far distant culture and time - okay, maybe in that simple mountainside hut - who knows she has a terminal illness and doesn't fight it. Perhaps she watches her progress, or regress, with some interest. If she is a Buddhist nun, say, she has often meditated on the inevitability of death.

But an American will say, "There's always a chance! There's always the possibility of a miracle," which Western doctors call "remission," meaning, the cancer has become less aggressive, and we don't know why. So this courage seems to consist in part of hanging onto a dream, no matter how shredded and remote. Hanging on to hope. Continuing to work when everyone knows working doesn't work anymore.

Let me say I do not now have cancer, as far as I know. August 12 I will celebrate twelve years since my surgery for breast cancer. I do have kidney failure, and now the as-yet undiagnosed heart thing. And there's Tom, shaken and further handicapped by breaking his arm when he fell just walking across the carpet in our own house. A moment of inattention, lost balance, that's all it takes.

I feel very burdened by this idea that admirable people are those who fight, and who do so "courageously." It's hard enough to do what seems to be the right thing, go to the doctors, watch the diet, undergo the tests and the misery of hospitalizations, do the exercises, wear the event monitor and the orthotics and the tennis shoes. Do I have to do it with a cheerful attitude?

Yesterday I told my Chinese doctor that I have been put on Hold on the transplant list because I can't take steroids. He seemed genuinely shocked. We all thought he was helping me hold on until I got the call. I was working my way up the list. I had a future. It promised new problems, but also renewed energy. It is a bitter irony to me to see the sudden flurry of interest in kidney donation - the Boomers, who are five or six years behind me, are turning old, and they always change things. If they want kidneys, there will soon be a universal donor law in place. No longer will we have the spectacle of thousands of people dying every year, waiting. (As an aside, I wonder what portion of the extraordinary expense the universal health coverage will pay?)

The famous definition of courage is Hemingway's, "grace under pressure." What did he mean by that, I wonder? He had faced wild animals, bulls, guns. He defined the heroic masculine life. But after a continuous string of physical and mental illnesses, even he was finally no longer able to fight.


  1. Some time ago, I found a book that addresses this very thing. It is called, Speak the Language of Healing: Living with Breast Cancer Without Going to War. Not that you needed more books or anything, but it is heartening to know that there has been some deep reflection on this very issue.

  2. You know I read your post and I felt so bad about the type of healthcare given in this country. With the power and the wealth of this country, US healthcare should be number 1 in the world. And what is it? 24th ? France is no. 1 and Italy no.2, the people there have 1/3 less heart disease and ½ less Alzheimer. They treat healthcare as a right of a citizen, just like having a police force for security and firemen to help stop fires – it’s all the same. But then, in the US they are so sure of their superiority that they won’t admit that other countries can do better, and then the US people suffer. The pharmaceutical corporations are so rich and greedy that they can constantly air ads to scare to ignorant, so I don’t know if anything will be done soon. My husband had a “turista” while we were going through a small town in the west of France. I went to a doctor I did not know, he came back with me to the hotel, treated my husband (a Saturday) and it cost $40 plus $15 for the medicine. I hope you get better and I am sorry that I got mad on the US healthcare but I am so tired of listening to all the distortion on TV.

  3. Our system is definitely broken in so many ways. But beyond that, I really think you bring up the deeper questions about how poorly we handle death here. Death is to be fought against at all times, even when it's obviously coming. Few of us have had much experience with the actual process, and seeing the body afterward, because it's hidden away in hospitals and nursing homes, and other places. And yes, we expect people to handle dying in a certain manner, instead of embracing how the person is when they are going. Isn't that a better plan, to just take one as thy are during their last days? But to do that requires that you've made some peace with death itself, which in a society like this, requires a lot of hard work.

    p.s. great Hemingway photo.