FOR four years I've been battling (as they always say) cancer, and now I've lost. I'm told I have the proverbial six months to live -- which I might, with luck and additional chemotherapy, be able to stretch to a year. The sarcoma that appeared in my right thigh in the summer of 1992, that first metastasized in my lung in 1994 and cost me a kidney a year later, has now spread all through my lungs. Beyond doubt I'm dying. Nothing unusual here, of course -- except that I find I not only am reconciled to my fate but also have achieved a strange kind of happiness that's new in my experience.
In 1979 I had another cancer, a melanoma that was removed in a simple outpatient procedure and did not recur. But by the end of my first year of treatment for the sarcoma, with chemotherapy, radiation, surgery to remove the original tumor, more chemotherapy, I had descended into a depression so severe that all sense of self was gone, all desire, except for a persistent, repetitive series of affect-free fantasies of specific and detailed ways I might kill myself.
I doubt that I can account fully for the level of happiness, even euphoria, I've now reached, three years later and in the face of much worse news. But some of it comes, I'm sure, from the fact that since the cancer's appearance in my lung in the summer of 1994 revealed that the original treatment hadn't eliminated the disease, and thus the statistical odds of my surviving were close to nil, I have determined to be open and honest with other people about my disease and my prognosis. I think this has also allowed me to be open and honest with myself.
My relationships with friends and family -- above all with my two daughters, now in their twenties, whose mother and I divorced when they were small -- have thus taken on an emotional openness and intensity almost inconceivable for someone who, like me, grew up in an upper-middle-class WASP family in the Midwest, a family in which the word "love" was never spoken or heard except, perhaps, to express admiration for an object or article of clothing ("I just love the way that sweater looks on you!"). So I find I'm not overcome with remorse or anger, or with terror of the fate awaiting me; instead I'm cherishing each moment, each mundane experience I have left. This is, for me, a magic time.
My own experience may be quite different from the experience of others in similar circumstances, or of those who love and care for them. But the general point here, a lesson I can share, is that for me over the past four years, after the traumas of treatment and of confronting my own death, the experience of dying of cancer may have been fundamentally about etiquette, about how one deals socially with people who don't have cancer and don't, for excellent reasons, really want to talk about it. Doctors, famously, need to keep professionally distant from their dying patients, and some even see such patients as a reproach, a token of failure. Friends and family don't want to seem intrusive or insensitive, and we are inevitably an unwelcome reminder of their own mortality. Nor are we who are about to die innocent of evasions and avoidance. I'd even guess that the popularity of cancer support groups stems from the chance not only to talk about common fears and experiences but also to be in a setting where this particular problem of etiquette, of figuring out how to talk to people who don't have cancer, who aren't dying, is for the moment suspended. Between the living and the dying a kind of wall seems to persist, a barrier of fear, shame, and perhaps most of all embarrassment.
I remember reading, back in the 1970s, a sociological study of paranoid behavior. Instead of analyzing the supposed paranoids for clinical symptoms, the researchers interviewed them and the people with whom they were routinely in contact: family, friends, fellow workers. What became evident was that when the supposed paranoids entered a room, these others actually did feel embarrassed and change the subject; they had been talking about the supposed paranoids behind their backs. So it is, perhaps, with the problem of etiquette for the dying.
Nevertheless, the wall can be breached; lines of communication can be kept open. As I say, I believe that my determination to keep breaching the wall accounts for my success in achieving acceptance and happiness in the face of my impending death. And this determination has extended even to strangers. People I've never met before -- people I run into in stores, or at roadside rest stops where I'm walking my dog -- ask what happened to the leg that was permanently stiffened by the removal of the original tumor. I don't put them off with "surgery" or "I hurt it." Briefly, I tell them what happened -- describing the tumor, the surgery, sometimes even mentioning my current prognosis -- and they're interested, concerned. Mindless pleasantry is transformed into actual conversation.
"Thanks for asking," I say to them, and I mean it.
"Hey," they reply. "Good luck!"
Worse things could happen.
To speak of manners in the context of cancer and dying may seem jarring, even insincere, but it shouldn't. For as the great novelists of manners, the Jane Austens and the Henry Jameses, all knew, the etiquette of communication and miscommunication, the comedy of understanding and misunderstanding, is not only deeply fascinating and entertaining but also profoundly significant. These novelists knew that once the misunderstandings have been cleared up, just before the ending, the possibility of love and of true communication has come to exist. And much more love, more interesting love, is possible than if no difficulties and misunderstandings had occurred in the first place. After all, you can't have the satisfying resolution of the ending if you don't start with conflict and crisis.