An Understanding of Mortality
Anna Leahy
In the introduction to Being Mortal: Medicine and What It Means in the End, Atul Gawande writes, “Death, of course, is not a failure. Death is normal. Death may be the enemy, but it is also the natural order of things. I knew these things abstractly, but I didn’t know them concretely[.]” Indeed, we all know these things abstractly and rarely concretely until faced with our own or a loved one’s mortality. In fact, one of the reasons I wrote Tumor was to understand more deeply the meaning of cancer and of dying. This is also why I read others’ books; we can understand terminal illness through an individual’s story of it.
In Grief Works: Stories of Life, Death and Surviving, psychotherapist Julia Samuel writes, “Grief starts at the point of diagnosis, when we can no longer assume, as most of us do, that we are going to live for the foreseeable future.” A diagnosis with poor prognosis brings a concrete sense that death is now within reach. We don’t know how we’ll handle that until we’re in it. “I was surprised by this [woman’s calm demeanor],” Samuel writes, “because it was far from what I imagine I’d feel in her situation, and yet it was authentic.” There exist various authentic ways to respond to dying.
The stories of those facing death offer alternatives to abstract thinking. This explains why neurosurgeon Paul Kalanithi’s When Breath Becomes Air and poet Nina Riggs’s The Bright Hour became bestsellers. Kalanithi understands as well as any patient with Stage IV lung cancer what’s in store. Even as an expert, though, he grapples with the loss of magical thinking. Riggs is told that her breast cancer can likely be cured—permission to continue thinking of death as an abstraction—but then must move from pondering survival to reflecting on the process of dying.
It’s a rare person, however, who is dying, wants to write a book about that, and has the skills and energy to see the project through. But Kalanithi and Riggs are not the only people to write their stories. Some are irreverent, in that they stare down magical thinking. Others share beautifully written, poignant reflections on daily life shaped and reshaped by terminal illness.
Cancer Made Me a Shallower Person: A Memoir in Comics by Miriam Engelberg, who died of breast cancer at age 48, is hilarious and uncomfortable. Her approach is summed up in the introduction: “maybe nobility and courage are not the only approaches to life with an illness[.]” This book challenges the stiff upper lip and the power of smiling, judgments about lifestyle, and even what age we think is old enough for a death not to be tragic. In one comic, only after the radiologist calls with results does the author consider that she should have taken the day off. Since she’s at work anyway, she composes an email to share the news: “I HAVE BREAST CANCER […] Also, the new Intro to Excel manual is finished.” This book is even funnier when you read it, both over the top and incredibly real.
More intellectual than Engelberg, Christopher Hitchens applies his acerbic style to his own dying in the slim Mortality, which he drafted as columns for Vanity Fair after a diagnosed of esophageal cancer. Importantly, he questions metaphors we use, saying “I’m not fighting or battling cancer—it’s fighting me.” Of cancer land, he writes, “the humor is a touch feeble and repetitive, there seems to be almost no talk of sex, and the cuisine is the worst of any destination I have ever visited.” He’d rather be living in pre-cancer territory. Later, he writes, “in Tumortown you sometimes feel that you may expire from sheer advice. A lot of it comes free and unsolicited.” Having cancer seemingly makes every aspect of life irritating, and there come dire consequences too. For one, Hitchens loses his voice. What might be racked up as symptoms and side effects have tangible, cumulative effects in an individual’s life.
Julie Yip-Williams was a lawyer who died of colon cancer at age 42. The Unwinding of the Miracle: A Memoir of Life, Death, and Everything that Comes After chronicles the course of her illness as well as secrets of her childhood in Vietnam. Behind her “ostensibly life-affirming acts[,]” she is “broken emotionally, more broken than I can remember ever being.” When paralyzed by “the fear and unpredictability of cancer[, …] the mind cannot form contingency plans; it cannot be brave and bold and forward thinning; it cannot accept what is without running from what will be.” Her patience in figuring out the tough moments and days gives this memoir tremendous depth. Through her story, any of us might “learn by the example of my death not to be afraid of death, to understand it as simply part of life.” That hope echoes Samuel too: “If we can take on board our impending death, as difficult and complex as it is, we might have the opportunity to shape our own end, which may also mean we are less fearful.”
Whereas memoirs run hundreds of pages, poetry distills experience. Claudia Emerson’s posthumous books include The Opposite House and Impossible Bottle, which explore loss and mortality amidst beauty in this world. The latter includes eight “Metastasis” poems and an “Infusion Suite” based on Emerson’s experience with colon cancer. Both Anya Silver’s Second Bloom and From Nothing explore actively living life with metastatic breast cancer. They are often not directly about cancer but also never far removed from it. In “Poise” (From Nothing), Silver compares herself to “[t]he little ballerina on my cardboard jewelry box” right down to veins in her ankles that crackle; she says, “I perform cancer.” Silver’s poems are intimate and burst with small observances and joys. She concludes Second Bloom with “To bloom is so foolish / that it must be wisdom.”
These stories by individuals facing death look beyond the medicalized version of terminal illness to offer wisdom from actual lives about our not-too-distant mortality.
Anna Leahy (@AMLeahy) is the author of the nonfiction book Tumor and the poetry books Aperture and Constituents of Matter. She co-wrote the handbook Conversing with Cancer. Her essays appear at Aeon, The Atlantic, Buzzfeed, The Pinch, The Rumpus, The Southern Review, and elsewhere and won top awards from the Los Angeles Review, Ninth Letter, and Dogwood. She directs the MFA in Creative Writing program at Chapman University. See more at www.amleahy.com.