What I want you to know

There’s this pressure among the sick, among those of us with cancer, to fight our illnesses as hard as we can. This pressure has a variety of sources: family members, friends, the culture at large (think cultural depictions of illness like well-known asshole Lance Armstrong), and even others afflicted with cancer. The pressure turns into a particular myth: one’s chances of survival depends on the character and personality of the one afflicted. If you are strong and if you fight and if you hope, you will survive, or at least live longer.

This myth, or a cousin of it, manifests itself among those who are not sick: “if you exercise, eat enough vegetables, meditate, think positively, pray regularly, don’t smoke, don’t drink too much, don’t eat too much red meat, etc, you won’t even get sick.” This is of course not true. Doing some of these things will reduce your chances of getting sick, but nothing reduces your chances to zero.

But for whatever reason, we have a hard time thinking in degrees. We would rather think in terms of either/or: if you did all the right things and avoided all the wrong things, then it is 100% certain you will not get cancer. So if you did get cancer, then you did not do all the right things or did not avoid all the wrong things.

(But rejecting this either/or leads some of us to make a different mistake: “if doing all the right things and avoiding all the wrong things does not prevent cancer, then there’s no point in even trying.” When you try to avoid thinking that everything is black or white, do not thereby think that everything is the same shade of gray. It’s still a good idea not to smoke.)

We know intellectually that there’s nothing that can prevent us from having cancer with a 100% degree certainty. But I suspect that you don’t really believe this. That is why I feel the pressure to tell you that I did not smoke, that I did not drink, I meditated regularly, exercised regularly, gave to charity occasionally, volunteered, etc. Not that I did all the right things. I probably ate too much meat. I probably should have given more to charity. I’m suspicious of positive thinking, and I never prayed. But those things I failed at are probably not what gave me cancer. It was a factor outside my control.

I want you to believe this, because I want you to believe that this disease is not my fault. I want you to have a good impression of who I am and who I was. But it is, I recognize, hard for you to believe that it’s not, at least in some small way, my fault. Because otherwise you would have to believe that there are factors outside your control that can affect your very existence.

In other words, if my being getting cancer was outside my control, it then means that whether you get cancer can also be outside your control – you too could be faced with a terminal illness. And vice versa, if you believe that this is something that only happens to others, then you don’t really believe that my getting cancer was a matter of chance.

I think in previous posts, I have said that I wanted everyone to believe that this can happen to them, just because it happened to me. I wanted you to believe that I am like you, because I wanted you to believe that I am sick through no fault of my own. But I didn’t realize what that means. It means that you have to be genuinely and deeply aware of the capriciousness of your own life. And that can be debilitating – anxiety-provoking. (Spouses, family members, and close friends of the terminally ill are known to suffer from death-related anxiety more acutely than friends of friends, acquaintances, and colleagues.) Facing not just the fact of your death but the fact that it might be out of your control can make living even harder than it already is.

And I don’t really want your life to be harder than it already is. So it’s okay to pretend that you’re exempt from all this. And it’s okay with me if you want to think it’s my fault I’m sick. Just keep it to yourself.

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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.