I assume this is not an unfamiliar question to anyone with a diagnosis of cancer: how much longer will I have?
In 2010 a team out of Memorial Sloan-Kettering Cancer Center devised a handy-dandy little nomogram, which is an old-fashioned method of quickly relating different variables, to estimate survival times in women with endometrial cancer. I found the article and the calculator shortly after my diagnosis and waved my results at my oncologist with glee, because they indicated a much better survival time than other studies. (My chances of making it to five years post-diagnosis were 83% by their calculations, while the usual tables indicated something closer to 50-50. Since then, the method has been validated by other researchers. Yay!) She didn't disagree; why would she? Because as she knew then, and I know now, there are no guarantees either way.
Of course, I do read many personal essays written by people with cancer, and this one by Paul Kalanithi published a few days ago in the New York Times stood out to me for a number of reasons, including one that doesn't really get addressed by this author but which I will discuss shortly. Here's an excerpt:
I began to realize that coming face to face with my own mortality, in a sense, had changed both nothing and everything. Before my cancer was diagnosed, I knew that someday I would die, but I didn’t know when. After the diagnosis, I knew that someday I would die, but I didn’t know when. But now I knew it acutely. The problem wasn’t really a scientific one. The fact of death is unsettling. Yet there is no other way to live.
This passage to me was reminiscent of one by David Servan-Schreiber in the introduction to the second edition of his book
Anticancer: A New Way of Life. Servan-Schreiber writes:
Seventeen years ago, I discovered from my own brain-scanning experiment that I had brain cancer. From the waiting room on the tenth floor of the oncology building, I remember looking down at people in the street--distant and oblivious, separated from its goal-oriented busyness and from its promises of joy, by the prospect of a probable early death.
It's the issue of awareness that connects the two passages for me. How many of us, pre-cancer, thought of death as something that would happen to us, eventually, but didn't expect it to arrive any time soon? In our first-world environment of generally good hygiene and public health safeguards, serious communicable disease is rare. Furthermore, the effects of basic public health measures are boosted for many of us who are insulated from the factors that contribute to the shorter life expectancy of poor people and people of color in all socioeconomic levels. For many of us, then, early death is not so common and not so close at hand except through accident or violence. (I do want to acknowledge that apart from cancer, there are many other life-threatening but not congenital conditions that can have similarly startling impacts on the people affected by them.)
I remember feelings of extreme vulnerability after my diagnosis, during chemotherapy, and then especially after the chemo proved to be a failure. At that juncture, I truly feared my days were numbered, perhaps in the low triple digits, and I think I did behave differently (though "better" or "more enlightened" would be a matter of debate). I was certainly highly motivated to change my behavior in terms of diet, exercise, and other ways that might influence my body's ability to survive. I think I was also motivated to be somewhat more mindful of how I would, if necessary, attend to important unfinished business.
But I can't honestly say that I followed through very well on all of those changes and goals. At first, I was stunned and felt as though I were in a fog. I didn't have the kind of heightened sensory awareness that I recall feeling after an especially good psychotherapy session, for one example. Instead, I often felt immobilized and overwhelmed, able only to face the task immediately in front of me--all the while feeling deeply aware of the possibility of not seeing one more birthday, one more graduation, one more milestone for myself or for my family.
So that's one aspect to consider: what happens if one's response to such a serious diagnosis isn't carpe diem, but paralysis?
Oddly enough, when I first achieved NED status is when I really felt empowered to start living somewhat differently--mindful of my mortality but not overcome by it. Now I had a window, open by who knew how much? But it least it was there, and it was open; I didn't simply have to fight to make it appear. And that's when I felt the most acute epiphanies.
But at this point, eighteen months into remission, I am sorry to admit that I have slipped back into some measure of complacency, both about cancer recurrence and about my mortality. Perhaps that's merely to be expected; it's not possible to live with such fine awareness for very long (at least, not without some very rigorous training). I find it much harder to keep up with my routines; I am not necessarily as tolerant and patient as I was for a while; I am mindful of my very elderly parents' frailty and impending mortality much more than of my own somewhat conditional survival. And perhaps that's all to the good.
The author of the New York Times essay has had only eight months since diagnosis, and for him those were pretty intense eight months, during which he has realized his prognosis is, first, completely unknowable and second, likely better than he feared. Will he reach a point of taking his survival for granted? Have I? Have you?
Monday Night Cancer Club is a Daily Kos group focused on dealing with cancer, primarily for cancer survivors and caregivers, though clinicians, researchers, and others with a special interest are also welcome. Volunteer diarists post Monday evenings between 7-8 PM ET on topics related to living with cancer, which is very broadly defined to include physical, spiritual, emotional and cognitive aspects. Mindful of the controversies endemic to cancer prevention and treatment, we ask that both diarists and commenters keep an open mind regarding strategies for surviving cancer, whether based in traditional, Eastern, Western, allopathic or other medical practices. This is a club no one wants to join, in truth, and compassion will help us make it through the challenge together.