How much time do I have left?

When I was first diagnosed with pancreatic cancer, I was given a terrifying number: 10. On average, someone diagnosed with Stage 4 pancreatic cancer has ten months to live.

And what sounds scary is the fact that I was given this statistic a little over seven months ago, which makes it sound like I have only about three months left to live.

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But this logic isn’t right. I have survived the last seven months (actually, I’ve lived the last seven months intensely), and so the number I should be concerned with is not

  • “How many months, on average, does the diagnosed Stage 4 pancreatic cancer patient, who has just been diagnosed, have?”

But

  • “How many months, on average, does the Stage 4 pancreatic cancer patient, who is still alive after seven months, have?”

The answers to these two questions are different, because they take their averages from two different sets of people. To answer the first question, your set would include everyone who’s been diagnosed with Stage 4 pancreatic cancer. And that means including all the people who did not make it to seven months: those who died within one month after their diagnosis, two months after their diagnosis, and so on.

But to answer the second question, you would not include everyone. You would exclude all those people who died within seven months of their diagnosis. And so the average number of months this group of stage 4 pancreatic cancer should be higher. In other words, the answer to the question “how many months do I have left?” should be more than three months.

The difficult thing is that I have no idea what the answer to the second question is or how many more months I actually do have.

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But I’ve recently got on good terms with uncertainty, which is a good thing, since uncertainty — about life and death no less — has forced its way to become my constant companion.

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Max Ritvo

When you laugh at something horrible, you’re just illuminating a different side of it that was already there. If you make something sad funny you’re much more likely to remember it. It’s a mnemonic device that makes our suffering rhyme with joy.

—Max Ritvo, New York Times, WYNC, New Yorker

I don’t want to die, but I will

The sadness I sometimes feel is just a result of this straightforward problem. I want something that I can’t have. The simplicity of this frustration is almost immature.

I’m hardly alone with this problem. The tension between what we want and what is going to happen is universal. It’s not just me. Almost all of don’t want to die, and all of us are going to (probably). There’s just an immediacy to my situation – I’m going to die sooner than most, and I don’t want to that to happen.

The wise advise against wanting something you can’t have – Buddhists, Stoics, whoever else. We must accept what is inevitable in order to live peacefully, with equanimity and calm. What good would it do, they ask, to want something impossible? What good would it do to resist change? How fruitful is it to rebel against nature?

And death, if it is anything at all, is natural. All living things die. That is about as universal a truth as you can get, without stepping into the abstract. It is a concrete reality, unfailing in its comprehensiveness.

But that death applies to all is only a statistical reality. It is a claim about how things have been thus far. There’s a tree, the Great Basin Bristlecone Pine, that is said to be over 5000 years old. Is it mortal? It can certainly die, from natural disaster or human ill will. But if it’s left alone, will it die at all?

Some might say that death is written in the laws of nature, but that, of course, is not literally true. The laws of nature are not written anywhere, not on any stone tablet, not in the holy books, not on the side of a mountain, not in the stars, not anywhere. And those who think they know the laws of nature are, I say, fools – fools for thinking they can rest assured in their supposed wisdom, fools for accepting ideologies as facts, fools for stifling their own curiosity with cliches. And yes, here I am, calling the Buddha a fool, Marcus Aurelius a fool, Yoda a fool, and all other holy men fools.

But I too am a fool. I want never to die; I want to live forever. This is about as foolish a wish that one could have. Nobody lives forever. Fact number one.

How could I be angry?

Time seems to slip away from me. Days and hours seem to go missing. Fatigue seems to be the most common culprit. Sleepiness and exhaustion take me down at unpredictable times.

I used up four days in the hospital last week, due to a fever. Fevers, if you are in chemotherapy, require going to emergency. You are given saline and a lot of antibiotics. It probably saved my life, and I should probably feel grateful. But it’s hard.

Before cancer, I would spend most of almost any day reading and thinking, but now it seems that I have to spend the hours I have on errands, in hospitals, going to and coming back from hospitals, leaving little energy and time for what matters to me.

But as often as it comes to the fore of my mind, I find that I cannot sustain my anger and my feeling of unfairness.

I am often grateful. When I heard about the earthquake in Japan mid-April, I felt sad for the victims, and grateful that I did not suffer their awful misfortune.

I think about all the people who have died in car accidents every year and about who will die this year and the next. Over 32,000 people die every year in car accidents in the U.S., and over 2000 in Canada.

I think about how sudden their deaths were and are — how they had no time to contemplate the rest of their lives.

I think about the 3 million children who die every year due to starvation. These children didn’t get to do what I have been able to: grow up, read books, make friends and lose a few, find love and experience heartbreak, to struggle and learn about the world and what it means to be human.

One should not think about fairness without thinking about the context. That is what fairness is, after all – what we have in the context of others. But real fairness, ultimate fairness, isn’t about how much you get compared to your brother or your sister, or how much you get compared to your friends, your co-workers, your neighbours, or even your fellow citizens. It’s about how much you have, and how much anyone has, in comparison to everyone in the world.

And by keeping that in mind, how could I, a man lucky enough to be born and raised in Canada, a country with socialized medicine and a stable economy, think himself the recipient of worldly unfairness? How could I — who have such loving parents and brother and sister, wonderful and devoted friends, a decent education, time to reflect, and the most wonderful partner — be angry with what I’ve been given?

How could I be angry in the face of all this? I’m not sure, but I do manage it from time to time.