Dying Well – A Reprinted Article by Dorion Rolston.

I don’t often do this, but I find this article I’ve just read from Aeon quite compelling so I decided to reprint it here for you. You should check out Aeon. It’s a great source for thoughtful reading.

https://aeon.co/ideas/dont-take-life-so-seriously-montaignes-lessons-on-the-inner-life

My dad was an unhappy man. He used to complain about the slightest thing being out of place – a pen, the honeypot, his special knife with the fattened grip. By the time his health really started failing, his arthritis so bad he could no longer get out of bed, his condition became all he complained about. ‘Dorian,’ he said, one morning over breakfast, the grapefruit cut up indeed with his special knife, ‘I hate myself.’ He was 86 years old and, I felt, nearing the end of life, so I took it upon myself to help him die as well as he could, a kind of Ars moriendi for the old man. ‘But Dad,’ I said, for the first time in our 32-year relationship. ‘I love you.’ When that didn’t help, I sent him some Montaigne.

Michel Eyquem de Montaigne (1533-92) lived a good, long life for a man in early modern France. By all accounts, it was a happy one, at least if his Essais (1570-92) – rangy discourses on varied subjects from thumbs to cannibals to the nature of ‘experience’ itself – are anything to go by. His writings, autobiographical in nature but highly argumentative, have survived him as somewhat radical (for the time) self-experiments. ‘Thus, reader, I am myself the matter of my book,’ he opens, with a letter of warning about the 1,000-plus pages that follow: ‘you would be unreasonable to spend your leisure on so frivolous and vain a subject.’ Since I took my dad to be also involved in so vain and frivolous a subject – namely, himself (right down to the urinary tract diagrams he drew for me on paper napkins at the dinner table) – I figured they’d have a lot in common.

The passage I chose to hand him, from the essay ‘Of Solitude’, concerned Montaigne’s secret to happiness. It says, simply: these are the things we normally think will bring happiness; they’re wrong, here’s mine. ‘We should have wife, children, goods, and above all health, if we can,’ he writes; ‘but we must not bind ourselves to them so strongly that our happiness depends on them.’ In what’s become something of a trademark for his life philosophy he adds: ‘We must reserve a back shop all our own.’ A back shop – or in the original French, arriere-boutique. Of course, this is metaphor. Of course, my dad took it literally.

What is there left for us to learn from Montaigne on the subject of happiness? For one, that ‘back shop’ doesn’t mean the room behind your place of work. Increasingly confined to his bed, in the crummy 17th-floor apartment that doubled as his home office, my dad read these lines with an eyebrow raised. Granted, Montaigne himself penned them from a castle-tower eyrie, overlooking the vast estate of his château. He didn’t mean for us to take refuge there – this privileged perch was just where he did his writing (as I do mine now in the storage unit behind my house, a heavy wooden partition setting me off from the boxes and mess). No, the physical ‘back shop’ is just a writer’s den, and this misunderstanding has caused critics to huff about Montaigne’s solipsism, as if what he really said was: Go be alone and make great art. This does not lead to happiness, I assure you.

When my dad emailed back, misreading Montaigne in just this way, he nonetheless conceded that the passage I’d sent him was ‘thoughtful’. But not, he added ‘surprising’, as ‘Many writers nowadays speak of personal space, meditation, being alone at times, and so on.’ He went on to say how there was a difference between voluntary and involuntary solitude. ‘Many of us, as we age, become too much involved in that space.’ It’s not just the confinement but the loss of all able-bodied experience that they’re missing out on, and my dad (as ever) listed them: going to the market, dancing, seeing family and friends – precisely the things that Montaigne cautioned his readers not to count on for happiness.

In her book How to Live: Or a Life of Montaigne in One Question and Twenty Attempts at an Answer (2010), Sarah Bakewell acknowledges the temptation to read Montaigne as an advocate for a type of isolation (chosen or not), but she qualifies this, saying: ‘He is not writing about a selfish, introverted withdrawal from family life, so much as about the need to protect yourself from the pain that would come if you lost that family.’ It was after the death of his closest friend and confidante, Étienne de La Boétie, and then later of his father, that Montaigne retired to his private library. In Donald Frame’s translation, this period is marked by Montaigne’s fall ‘into a melancholic depression, to combat which he begins to write the first of his Essays’. The contemporary US writer and essayist Phillip Lopate ventures that, for Montaigne, ‘the reader took the place of La Boétie’. But how, exactly, did Montaigne’s attempts (the literal translation of essai) assuage grief?

Certainly, an unnamed interlocutor haunts the text, the kind we usually chalk up to self-talk. Talking to people who won’t talk back (or who can’t because they’re no longer with us) is a form of conversational intimacy we might read as an extension of Montaigne’s general affability. In life, Montaigne was known about town as a raconteur with an open-door policy for guests. Even Bakewell, who sums up his back shop as a form of ‘Stoic detachment’, notes that in another lasting dictum Montaigne cried: ‘Be convivial: live with others.’ If Montaigne’s back shop is meant to mend a broken heart, then it is not by avoiding future pain, but by coming into a different relation with it.

Montaigne was well aware that the promise of getting away from it all was a fool’s errand since, wherever you go, you take yourself with you: ‘It is not enough to have gotten away from the crowd,’ he writes, since ‘we must get away from the gregarious instincts that are inside us.’ Instead, to quote Albius Tibullus, one of the Latin poets he grew up with, ‘be to thyself a throng’. This is where I hoped my dad might take note: shut in with no one but himself for company, there might still be a chance for great companionship. ‘We have a soul that can be turned upon itself,’ writes Montaigne, ‘it has the means to attack and the means to defend, the means to receive and the means to give.’ Sadly, my dad didn’t see his own soul this way and, after falling into a depression of his own, he took his own life.

I wonder now if Montaigne’s back shop was less the writer’s saving grace, lifting him from the depths of despair, but not the act of writing from within it? ‘Here our ordinary conversation must be between us and ourselves,’ he writes – and I take it he means that the quality of the inner dialogue will determine the quality of the life.

Montaigne’s mental chatter had a buoyancy to it, as he bounced from one subject to the next, going with the current. What I couldn’t convey to my dad, evidently, was this lightness of attention, distilled in that most famous of Montaignisms: ‘Que sais-je?’ (What do I know?) In his celebratory portrait of Montaigne, Ralph Waldo Emerson in 1837 comments that: ‘His writing has no enthusiasms, no aspiration; contented, self-respecting, and keeping the middle of the road.’ Not taking life quite so seriously – the pursuit of happiness notwithstanding – might then be Montaigne’s key to dying well. After all, there might be no surer inner peace in one’s final days than not needing it so badly.

Dorian Rolston

This article was originally published at Aeon and has been republished under Creative Commons.

Two Days in my Diary: Saturday morning addendum.

6:15 AM Saturday March 21st.

I probably should have included Saturday in my original post from yesterday, because it’s also a down day due to my chemotherapy treatments. I had another dex night last night. I got my usual acid reflux but it came much later than usual, around midnight, and lasted until around 5 AM. My tinnitus is about as bad as it gets right now. I slept, I really did, for a couple of hours between 10:30 and 12:30, then I got up to pee. I sort of slept again until 2 PM but that was it. I woke up startled by a very odd dream. So I listened to some music and read some Fernand Braudel about Medieval Europe while I tried to process this weird dream I had just had.

I woke up at 2 AM in a sweat. That’s not unusual either in the first three days after taking my meds, but this time, like I just said, I woke up from a very strange dream. I wouldn’t say it was a nightmare; it was much more matter of fact than that and it was very vivid.

So, in my dream I invented a portable guillotine. It was portable with a blade a metre long and 30 centimetres thick and sprung like a chop saw. It looked more like the cutting end of a pair of garden sheers than a traditional guillotine but it worked like a guillotine. I invented it to cut up yard waste like sword fern fronds and twigs, that sort of thing. I think it’s because yesterday Carolyn worked in the yard doing clean up and she cut up a lot of sword ferns to the ground. I guess I invented this ‘machine’ to chop up these fronds to make them more compostable rather than take them to the dump in the trailer. In any case, it worked well, but then someone stole it from in front of my workshop one night. I was pissed off but resigned to just building another one. Then the neighbours started reporting that dogs and cats in the area were turning up decapitated. I figured whoever had stolen my guillotine could easily be doing this. I was mortified. Then I wondered if we’d start finding people decapitated, maybe up the logging road. Now I felt really shitty. All of that mayhem was my fault for inventing such a dangerous tool. Then I woke up.

I’ve been wracking my brain to try to wring some significance out of this dream but I can’t seem to figure it out. I invented a dangerous tool for a good cause but then found it used for very destructive purposes by person or persons unknown. What can I make of that?

In any case, today will be strange. I’ll probably have to sleep much of the afternoon after I completely come down from my dex high and am left to deal with the fallout from the cyclophosphamide and bortezomib. For my headache I’ll take a couple of Tylenol. Strange, but my peripheral neuropathy is attenuated at the moment. I wonder how long that will last. The burping is driving me nuts!

By the way, I came up with my epitaph. It goes like this:

Here lies a man who did a lot of bad things in his life.

Here lies a man who did a lot of good things in his life.

At the end he hoped it all balanced out and he would

Neither go to heaven nor to hell. He, he, he.


Have a nice day.

To live and to die.

Yesterday we went to the lab for the nth time so that the tech might gather some of my mucky blood for analysis. My last trip to the lab was fine, but the results were incomplete. Apparently there was a problem with one of the samples that had to be shipped to Victoria so the results weren’t available to us. Samples requiring electrophoresis in their analysis are sent to Victoria. Apparently there have been some issues with the transport of samples. Maybe the samples coagulate on route, maybe they get lost. Who knows. All I know is that the results of these lab tests tell me how I’m doing and can give me confidence in asking the right questions of my oncology team. It’s okay this time because I just got a new set of tests. They’d better come back readable, that’s all I have to say about that. Hear me VIHA? Now, on to more important things.

I wrote this at the end of my blog post entitled Overdiagnosis? I promised to get back to it so here we go.

In my view, my destiny is to die. Like all other living things on this planet, living and dying are the same process and life depends on death for its continuation. No death, no life. I feel that in my very bones! That’s where my oncology team is doing battle with my own body to try to keep me alive a while longer. Of course, eventually whatever the oncology team will do won’t be enough and I’ll die.

So, how exactly does the body shut down as it’s dying? Cancer may very well be one (a very important one) of the mechanisms that is ‘natural’ in its role in having us die. Maybe cancer is not the pathological evil that it’s made out to be. What would happen if cancer did not exist? How would we die then? What does it mean to die of natural causes? How can we figure that out?…I think science and medicine have a lot to learn about us yet.

So, let me address one question at a time. Our bodies are ephemeral things, programmed to ‘die’, which means programmed to return them to the pool of raw material available to other organisms as they organize matter into various structures, themselves programmed to ‘die’. The body ‘shuts down’ in a number of ways depending on circumstance at the time of death. If you get shot in the heart, the process is quick, but immediately cells ‘know’ what’s going on and act accordingly. When my mother died, the nurse in the care home where she lived explained that staff can tell when a person is close to death by looking at their feet and legs. The weaker the heart gets, the less it can pump blood to the extremities. That means that the feet, then the legs show progressive signs of blood loss, losing colour and tone. Maybe that will happen to me. Whatever the circumstances, our bodies are prepared for the moment of death and ‘know’ what to do. Our minds are another thing. I’ll get back to the mind in my next blog post.

Cancer is as natural a process as muscle building. In my case, the likely culprit in triggering my myeloma is an oncology gene, not a factor exterior to my person like an environmental carcinogen, and my immune system was likely complicit in making sure myeloma spread to all of my bone marrow. My bone marrow, it seems, just got tired of producing marrow and started to produce myeloma protein instead, crowding out the cells that produce hemoglobin and other healthy blood cells. I really don’t think that that is a pathological process. Pathology implies that there’s something wrong with the body breaking down and dying. There isn’t. Dying is as natural to us as being born. The problem is that our big brains have a hard time letting go so they unleash our minds in a futile battle against entropy. Ultimately, they deny death itself. We’ll get back to that next post.

I think it’s reasonable to ask the questions I pose above: What would happen if cancer did not exist? How would we die then? What does it mean to die of natural causes? If cancer and other ‘deadly diseases’ didn’t exist we’d die from other causes. Simple as that. So, if medicine eventually ‘cures’ cancer or heart disease, or stroke, it will just have to move on to do battle with whatever other cause is determined to kill us. Scientific medicine is based on a pathology model so is organized to do battle with disease and death. That means that it assumes that there are normal ways to be a human and pathological ways. The idea is to ‘fix’ the pathological ways to bring the human back to ‘normality’. Unfortunately, there is no way to fix death, although there are a variety of ways of conceiving of death (but that’s the subject of my next blog post.). So what would happen if science gave up on the pathology model? It would have to study what is ‘normal’ human development, and not be fixated on correcting what “goes wrong”. It would have to cease thinking of disease and death as evil. Of course, evolutionary models are gaining in importance and they aren’t pathologically based. Furthermore, I’m sensing glimmers of the recognition of the weaknesses in the pathology model in the medical clinic, but pathology is a strong draw and won’t likely go into abeyance anytime soon as a favourite basic framework for the practice of medicine. I figure that until science and medicine face reality, the suffering sometimes caused by attempts to prolong life will have to be closely scrutinized along with the Hippocratic oath, and we won’t be able to deal with death as a natural part of life. So where does that leave me?

I can tell you that I’m not convinced that chemotherapy is the best course of action for me. Yes, it will likely allow me to live longer, but how long? And in the meantime, I get obsessed by my lab results and Carolyn and I reckon time by where I am in my chemo cycle and how that makes me feel. Not sure that’s such a good thing.

Well, this is a pain in the ass!

Literally. Although technically, the pain is in my hips. But as you know, hips are very close to asses so I feel justified in using the title above.

My hips have been giving me a bit of grief lately but usually only in bed at night. They don’t hurt during the course of the day. I tend to sleep on my side, usually my right side. I’ve noticed over the past few weeks, however, that over the course of a night, I might have to shift my body from my right side to my left side every hour or so. I could take more hydromorphone I guess, to alleviate the pain, but I feel like I need to have some idea of what’s going on in my body. Trying to eliminate all pain all the time seems ridiculous to me. Us humans are built in such a way as pain is pretty much a given whether from overuse, as in doing too much exercise, from injury via trauma, or from things like appendicitis. I want to know what’s going on in my body and it’s pretty hard to do that if I’m always zonked out on opioids.

Pain, pain, pain! I’ve had lots of that in my lifetime although just looking at me you wouldn’t know that. I look pretty good for an old guy. Still, pain has been an expected companion most of my life. Mygawd, in my early twenties I had a laminectomy, a disk removed in my the lower back because of a planer mill accident, but I’ve already mentioned that in a previous blog post. I had to be peeled off the ceiling a number of times from that one. No pain has ever stopped me from doing things, however. It may have stiffled my dreams of being a world-class athlete, but it never stopped me from running and walking fairly long distances, and farting around in my shop and studio. Of course, I had to be careful. Sometimes my back would send out signals for me to back off, and I would, not being a complete idiot.

A few years ago, though, I had had enough with pain and my doctor had had enough of me complaining about pain, I guess, so he sent me to a pain clinic in Nanaimo. Well, that was interesting. I assume that pain clinics are good for pain caused by overt trauma and that sort of thing. My experience is that as far as chronic pain is concerned, they struggle with coming up with good solutions. At the end of my time at the clinic, they were thinking of implanting a tens machine in my side at the site of my 2002 kidney surgery. The site of my kidney surgery from 2002 still pains me. However, I wasn’t about to have a tens machine implanted in my body so the clinic and I parted company. The clinic still exists doing lots of good, I’m sure, and I still exist too, still in pain. Well, there ya go!

Over the last few months, as you know, I have been diagnosed with bone marrow cancer, just another reason to have pain. I have no shortage of reasons to have pain. Now, however, my family doctor is only too happy to prescribe opiates. He’s always been fairly liberal when it comes to prescribing pain medications, but now I especially appreciate his willingness to treat my pain with whatever it takes. One thing is that treating the pain from my bone marrow cancer also has the benefit of dealing with some of my chronic pain issues. That has been good although I’m still in pain. I’m certainly not trying to eradicate all my pain. Feeling pain means I’m still alive. Of course eating sticky buns has the same effect, but that’s a lot more pleasant than feeling pain as an indicator that there is still life in these old (now eroded) bones.

My oncologist, however, seems to be clueless about pain. When we visited him in Victoria last year I was in a lot of pain, obviously so, I thought. He told me to take a couple of Tylenol. He, he, he. A couple of Tylenol? Sure, dude.I can’t imagine he’s ever felt any kind of acute pain so he just can’t relate. Ibuprofen works well for me, but I can’t take anti-inflammatory meds because I have only one kidney. Pity. I think I could avoid a lot of opioid use if I could take anti-inflammatory meds. In any case, my oncologist, in exasperation, I think, because I keep telling him that I’m in pain, and he doesn’t want to hear that, decided that I should go to a pain clinic. Well, I was not particularly receptive to that, but after a little deliberation with Carolyn, I decided to humour him. So. off I go to the pain clinic only it’s not called that.

Yesterday, I got a call from ‘Leanne’ from the Palliative Symptom Management Clinic which has a branch here in the Comox Valley. Now before you get all weirded out by the word ‘Palliative’ in the title, don’t worry, I’m not getting signed up for end-of-life care just yet. Palliative care, it turns out, refers to pain management in general. We’ve come to associate it with end-of-life care, but it doesn’t have to refer to that. Leanna had lots of questions for me like: do you have a gun in the house? Are you depressed? Do you have place for the nurses to park when they come to visit you?

I’m looking forward to seeing what this palliative care group can do for me. The doctors involved may have good advice for how to manage my pain meds. Eventually they can hook me up to a huge bottle of morphine and I can blissfully drift off to permanent unconsciousness, but not just yet. My lab results are indicating that I’m heading toward remission so back off with the bottle of morphine!

We saw my orthopaedic surgeon yesterday and he’s ordered another CT scan of my right femur, the one with the bone excavations. He just wants to make sure the lesion isn’t getting any bigger because it has been more painful lately. So, next week I see my family doctor on Monday, then I go into the hospital on Wednesday for a visit with my local oncology GP, and to get a zoledronic acid infusion. I’ll probably get a CT scan this week too. On Thursday I go back in to start a new chemotherapy cycle, my third! Never a dull moment. Wish me luck!

When Death Comes Calling

Don’t worry. I haven’t gone completely morbid or so focussed on death I’m forgetting how to live. However, I’ve been fascinated my whole career on the overwhelming but often covert death denial we have built into so many of our institutions and which is at the core of much of our morality.

That’s one reason I was amused, yes, amused, when I came across this YouTube video of a long retired philosopher who in his 97th year of life, after a career writing about death and dying in an abstract sense often poo-pooing our personal fear of dying, come around and admit that he was scared. He was scared of dying. He’s dead now, but in this video we get a pretty good sense of what he was going through in the last few weeks of his life. It’s not about cancer. I figured I’d give you a bit of a break from that for one blog post.

So, Herbert Fingarette, author, teacher, husband of 70 years to the same woman (who died seven years earlier), devoted rationalist and philosopher (Stoic I expect), writes about death and dying in an almost flippant manner, virtually sniggering at the weakness of being fearful of death. Then, he’s ninety-seven years old and on his way out. He knows that, and now he’s scared. He still has time to be scared. His question is: “What is the meaning of all of this?” Well, that’s a legitimate question, one that Tolstoy asked himself about his life and work as he lay dying. Truth is, there is no meaning. No cosmic meaning that’s for sure.

I also wrote some (no books, mind you) about death and death denial from sociological, psychosocial, and anthropological points of view mainly through the work of Ernest Becker, the author of several books, the last one being entitled Escape from Evil. I do a detailed review of Escape from Evil in the early days of this blog. You can do a search for several posts on Becker by using the ‘search’ function on the right scrolling menu of this blog. Here’s an example:https://rogerjgalbert.com/2017/11/

One of my favourite BBC documentary presenters is Brian Cox who is an astrophysicist and has a beautifully produced series of documentaries on the cosmos, entropy, life and death. For him, everything, every structure comes into being using materials in the environment, grows, matures, then decays into its constituent parts and dies. Ocean floors are pushed up into mountains, sharp at first then eroded finally into plains and flatlands. Galaxies come and go. The whole universe is destined to die. For us, following Ernest Becker, death and disease are the twin evils of our world. Of course, we need death because we usually eat dead things. We need death to live. It’s when our own lives are at stake that things go messy in our heads. We don’t mind death at all and we’re quite willing to inflict it on anything we wish to shove down our gullets or we think might be a threat to our continued existence. The movies these days are full of death and destruction, but it’s always of the good kind, when threats to our existence are defeated. It’s a lot more complicated than I’m portraying it here. There’s a lot more explanation in the archives of this blog.

We don’t mind killing things, other animals, including humans. Some of us glory in the idea. As Becker points out, war is a venue for the creation of heroes. Some people trophy hunt to show how tough they are. So, it’s not death that bothers us so much, it’s death with insignificance.

I have no evidence of this, but it strikes me that most of us don’t think about death and dying on a regular basis, we have way too many other things to think about, like where the next rent payment is coming from or how can I confront my cheating husband or wife, or whether to get a latté or mocha on the way to work. Decisions, decisions. Way too many to be meditating on death. It’s true, the closer we get to dying the more immediate the threat, the more we sit up and take notice. Some of us deny the terminality of our own lives until our kidneys stop working in the last few hours of life. Some of us, if not most of us, push the thought of death and dying so deeply into our subconsciousness that it barely has time to surface even at the moment of death. “What, I’m dying? Nah, must be a mistake! Check my numbers again.”

Right now, I’m trying to conjure up my last moments on earth. It’s not coming easily. Sometimes I get scared, but mostly I’m curious about the process. I’ve been thinking of talking to a death doula to see how they approach coaching someone who’s dying. See, I can still intellectualize dying, but before I know it, I’ll be face to face with it and no denial will be possible anymore. Will I be like Herbert? I don’t think anyone of us knows for sure how it’s all going to do down. I certainly don’t, and it’s the uncertainty that is probably the most frightening thing of all.

Today is not a good day.

Yesterday was okay. The day before was fine, but it’s hard to predict from day to day what my day will be like when I wake up in the morning. When I woke up this morning I knew that I wouldn’t be having a good day and contemplated just staying in bed. I try to maintain a modicum of a schedule so I like to get up around the same time every day although over the past couple of weeks my rising time has shifted a bit to the 8 AM side and is less inclined to stick to my former rigid 7:30 AM time.

I know my day won’t be a good one if I wake up from an unsound sleep with my body in full tingle mode, especially if it’s accompanied by the sensation of spiders crawling all over my legs. My reaction to my first cursory assessment of the state of my body is to hunker down, pull the covers over my head, and forget about it. But I don’t do that, do I. No, I get up, stagger into the bathroom clutching my cane in the hope that it will help me maintain my balance, and get myself into the living room where I usually plunk myself down into my recliner. I know I will spend the day in utter exhaustion reluctant to even get up to pee.

This pattern of not knowing until I wake up what my day will be like has been going on for years. That’s nothing new. I have no idea what differences in my daily routines will be wrought by the new chemical soup I will be ingesting in various ways as the oncologists stir up a new chemotherapy routine for me next week. The chemotherapy is bound to throw things out of whack in lots of ways some I can prepare for, some I can’t do anything about. Over the years, I’ve almost gotten used to being restricted in my mobility, but in fairly predictable ways. If I wanted to do something, like attend a meeting or go to a concert, I would know that if I did that I’d pay for two or three days after with exhaustion and pain. It was unthinkable to contemplate attending an event two days in a row or doing simple jobs around the property after a previous day of activity. My life has become less and less social over the years.

Truth be told, I’m a little depressed. The time between chemotherapy treatments has given me time to think, and thinking often gets me into trouble. So, I did an evaluation of my life to date going over high and low points, achievements and regrets. Probably a mistake, but one I’ve frequently made so I’m familiar with it. I even looked at pictures of myself over the years, from the time I was around two years old to quite recently. I thought about the different stages of my life, my time at home with my family, my time away to boarding school in Edmonton, my crazy teen years, working with my father, college, university, marriage, teaching, volunteer work, art, woodwork, etcetera. Then on top of that I overlaid health issues that I’ve experienced. I don’t need to go over all of my health problems here, but I had a few broken bones along with the discovery in the early 90s that I was vitamin B12 deficient and that I would need to inject B12 into my leg every month or so for the rest of my life. The discovery of my B12 deficiency was made when I complained to my doctor about fatigue, brain fog, dizziness, and that sort of thing. In 2002 I had my left kidney removed because I had renal cell cancer. Later I had an appendectomy. Still, I complained of fatigue, brain fog, dizziness and vertigo. There is a high incidence of Multiple sclerosis in my family so we chased that for a while but found nothing. Recently I was diagnosed with multiple myeloma which makes sense of all the other symptoms I’ve been having. I’ve probably had ‘smouldering’ multiple myeloma for years. So, now, I come to this:

I’m 73 years old (very close to it). I have bone marrow cancer, one kidney, B12 deficiency, degenerative disk disease (in my neck), arthritis, and who knows what else ails me. I’m old enough to die as Barbara Eirenreich argues and I’m okay with that, but the suspense is killing me. I’m being told that I could live quite a few more years with a few good ones thrown in there too. Still, I have incurable cancer and old age is coming after me. I’m beginning to envy people who die of sudden heart attacks or massive strokes. They have no time to think about all the things there is to think about.

I’ve discussed this with a friend of mine who also has multiple myeloma and his idea is that he doesn’t focus on his disease at all, or on his age, or any other potential killer. No, he focusses on what needs to be done: the shed needs a new roof, the canoe needs a new skin, baseboards need to be installed, grandkids need hugs. Dying will take care of itself when there is no other option, when it goes to the top of the priority list and refuses to be ignored any longer. I find myself thinking the same way. Yes, I get a little depressed when the extent of the threats to my life are displayed in front of me, but I get over it pretty quickly.

And I think about life and death. They aren’t opposites as we generally think of them. They cannot exist without each other. My life, like the lives of the nine generations of my ancestors who have lived in Canada are blips or interludes in the continuity of time and space. Mushrooms are a good analogue for us, I think. They push up through the ground cover from the mycelium below, flowering for a bit then melting back into the biomass to contribute again to the mass of life on this planet. Of course, for most of us in the course of history, thinking of ourselves and our species primarily as biological phenomena hasn’t been enough. The fact that we are temporary agglomerations of matter is not terribly satisfying for us and our big brains. We’ve loathed death and we deny it in every way we can, individually and socially. I try to face death as I face life. I try to put my life, my history, the phases of my body’s growth and decay in the broadest context I can. I don’t care to give them more importance than they are entitled to in the context of life on this planet.

My post on the social inequality in Emergency Departments is coming but my next one is about our immune system, the traitor that it is.

I Have Cancer. Damn!

I was recently diagnosed (late September) with multiple myeloma or bone marrow cancer. My bone marrow has gone buck wild and is producing way too much of a particular substance the pathologist euphemistically calls ‘muck’. I’ve probably had it for some years, but the symptoms are very similar to those of other diseases and conditions making it difficult to diagnose. I’ve not been well for years. The past two years have been especially difficult and the last four months almost unbearable. I’m still functioning, but at a much-reduced level than I’m used to. 

This isn’t the first time I’ve had cancer. I had kidney cell cancer in 2002 and had my left kidney removed in an operation that left me with one (fully functioning) kidney. Now my remaining kidney is compromised because of the multiple myeloma so things aren’t looking particularly good for me. There are still tests to be performed and a prognosis to be arrived at, but as soon as the test results are in the BC Cancer Agency in Victoria will give me a call and arrange an interview and set a course of chemotherapy. A lot will depend on the stage of my myeloma. Some people do very well with chemotherapy and new drugs are being developed every day to target the specific pathogen that’s attacking my blood. I still may squeeze a few more years out of this old body of mine yet, but the next few weeks will tell the tale. Multiple myeloma is not curable, but it is treatable. 

I’m not afraid of death. I’ve often written about death and the cultural systems we’ve created to deny death, which actually build on our natural, biological aversions to disease and death. As you can easily ascertain by reading my blog this has been my main focus over the past few years. Dying is another matter altogether. I’m not particularly afraid of that either, but it is full of unknowns. I’m going through the various stages people do when faced with this kind of diagnosis: grief, anger, sadness, self-pity although these feelings are fleeting, and I soon get on to more positive emotions. I feel some guilt too. Yes, guilt. Guilt that’s impossible to escape in this culture. Guilt for succumbing to disease and death, the twin evils that we’ve identified as the greatest threats to us. In moral terms, and culturally, we abhor weakness, physical or social. Sick or poor people are to be feared in our culture. We tend to marginalize both if we can, but that’s not always possible because the world is not as simple as that.  

I know I’m on my last legs. I’m almost 73 after all and have had a great life. Nobody gets through life avoiding death except in novels and movies. I have no idea how long I have to live, but whatever time I have I just hope that my quality of life improves enough so that I can finish some paintings I’ve been working on, maybe re-canvas our canoe and continue writing this blog. In fact, I’ll use this blog as a kind of journal chronicling the process of being ill, then diagnosed, then treated. Stay tuned. 

Please don’t suggest any treatments or diets or whatever. I won’t be going to Mexico for any heroic treatments. (If and when I feel better we may go to lie on a beach though.) I’m not desperate. I won’t be buying a juicer either and I’ll continue to eat the great, wholesome mostly unprocessed food that I currently eat but my body will follow, as it must, the second law of thermodynamics. I’m okay with that.

I’m a Cancer Survivor but I won’t be a Life Survivor.

It seems odd for me to describe myself as a cancer survivor. Oh, I had cancer, alright. In 2002, very early in the year, I was diagnosed serendipitously with kidney cell cancer. I had gone to see my GP about acid reflux so he sent me to to the hospital to have an ultrasound to check it out. The ultrasound tech wasn’t looking for anything in particular is my guess, but she zeroed in on my left kidney and sure enough there was a lesion there that they strongly suspected was kidney cell cancer. The techs didn’t tell me that, of course. They don’t discuss the results of a scan with patients in my experience. My GP was the one to break the news to me. His office called me to tell me the doctor wanted to see me at 5:30 the following day. I didn’t think much of it at the time, but in hindsight, that was an unusual thing for my GP to do. In any case, he broke it to me and said that the best chance of a full recovery for me was surgery as soon as possible. Then he sent me off to see the urologist who would perform the surgery. They didn’t perform a biopsy they said because of the fear of spreading the cancer which at that point was restricted to my left kidney. Fair enough.

So, after all the preliminary tests were done and I had seen the surgeon and the anesthesiologist my surgery was scheduled for the third week of February. Normally, of course, I would have been teaching at that time, but that wasn’t going to happen so the college arranged for subs on very short notice, one of whom was to die of cancer a few years later. The thing is that there are no obvious symptoms with kidney cell cancer. As far as I know, it doesn’t usually affect kidney function, so my kidneys didn’t show any signs of stress or disease. I felt fine. I did some work around the property. It so happened that we were just in the process of buying a new place in Cumberland, BC when I was diagnosed. There was a lot to do. We had an acre of property with the house and several outbuildings. It was a good thing that I wasn’t particularly debilitated. That was to come later.

Needless to say, a cancer diagnosis is traumatizing for everyone involved. I was concerned for my family as much, if not more, than for myself. Strangely, I was convinced that this cancer wouldn’t kill me so I was pretty upbeat about the whole thing. Why I felt this way I have no idea. It could be I was in denial. We humans are great at denial, even me.

Finally, I had my day in the operating room. I arrived at the hospital with Carolyn early in the morning with hardly anyone around. We said our goodbyes and I was taken to the pre-op area. They didn’t waste any time getting me ready and into the operating room. That I remember. My GP was in attendance and assisting, although I didn’t see him in the operating room at the time. Later, my GP told me that the surgeon had cut me in half laterally on my left thoracic area so that the kidney could be gently lifted out helping to keep the cancer contained. He said it was quite daunting. That’s what happened. Since then I’ve made do with one kidney. One of my former students was a nurse in the OR. We joked around until the anesthetic kicked in. Having a former student in OR isn’t unusual because many of my students were in the nursing program and were taking my sociology courses as electives. It happened again last year when Carolyn went in to have her appendix removed. My former students are everywhere!

I tell you all of this so you get a sense of what I mean when I say I’m a cancer survivor, but I find it hard to describe myself as such. I think of cancer survivors as people who have had to struggle for weeks, months or years on chemo and/or radiation, losing their hair and being in horrible pain the whole time. I have known many people who have succumbed to cancer, but I also know a number of people who have fought it, and fought it valiantly for long periods of time and survived. My cancer recovery was not at all long and drawn out. The surgery put an end to it. Done. Well, mostly done. My surgery was seventeen years ago and my left thoracic area has been a source of constant pain since then, aggravated often by the slightest movement. The pain in my side never lets me forget about the cancer that almost claimed my life. It gets pretty tiresome at times and saps my energy, but I carry on because what else is there to do? No, suicide is not an option.

So, I guess I’m a kind of cancer survivor, but I won’t be a life survivor. No one has ever been, nor will anyone ever be a life survivor. Nothing can ‘cure’ us of death. My surgery has allowed me to live longer and that’s fine, but I’m still in line for dying. And that’s fine. I don’t have any illusions about life and death. Life demands death. Life cannot happen without death. Denying that gets us nowhere. So, every day is one more day to enjoy and struggle over. When it’s done it will be done. That’s it. I know that some of you might think it odd that I say it, but if I had died on 2002, that would have been fine too. Carolyn and my family would have been sad and would have mourned my loss, but they would have gotten on with their lives. That’s what we do when people close to us die, we get on with our lives until our turn comes.

Beauty in Death

Alder leaves – Skeletonized by alder flea beetles

The photograph above is of skeletonized alder leaves caused by alder leaf beetle larvae. The adults chew holes in the leaves while the larvae leave the ‘skeleton’ of the leaf intact but strip it of the ‘meat’ of the leaf.

We have several alders on our property and they all look terrible with leaves dropping or dead but still on the tree. From what we’ve read on the internet the trees generally survive an alder flea beetle infestation, but I’ll believe it when I see it. Of course alders lose their leaves in the fall, but ordinarily, the leaves drop off in a heavy wind and are generally intact yet brown. The skeletonization of alder leaves is the product of the little black alder leaf beetle larvae. The effects of the two processes are entirely different and are obvious upon inspection.

But enough technical stuff. The point of this post is that I find these skeletonized alder leaves quite beautiful. I love the intricacy of the connections of the veins. I love their strength. I haven’t used these particular leaves as a drawing subject, but I have drawn skeletonized leaves.

I can’t remember just when I drew these skeletonized leaves, which are not alders, but it was a few years ago certainly.

It’s difficult to see death in these leaves because we hardly see life in trees at the best of times. Forest companies don’t deal in trees, don’t you know, they deal in ‘fibre.’ When we see a load of logs on a logging truck going down the highway we don’t think of death (if we think of anything at all) related to the truck and its load. I have no real evidence to write this, but I do understand the culture and the language that denies death and this has that culture and language all over it.

That said, there is death in these leaves. They are dead or at least fully within the process of disintegrating and becoming compost for future plant growth. Their ‘meat’ is gone and all that remains is their ‘skeletons’. I find beauty in skeletons. I’m not sure why. We have lots of bones around here, bits and pieces from various deceased animals including a mouse, a tiny bird, raccoons and deer. Skeletons, for some reason, at least clean and bleached ones, have a simplicity and elegance that is always hidden in life. They require death to release them from their ‘meaty’ cover, to bring them to our attention, and to give them life. Maybe that’s why I find them so attractive.

I watched our dog die the other day.

Actually I’ve watched all of our dogs die except two. The only two we didn’t watch die were Little One and Chitka. Little One because she was no longer in our care. It was a long time ago and we had to give her up because where we were moving to wouldn’t have her. With Chitka, neither Carolyn nor I had could go in when he was euthanized. Too painful. All the others, Cedric, Oren, Max and recently, Wilco, all died at the hands of a vet with us present. They were all old and ready to go but that never makes it any easier. None of them did us the favour or dying in their sleep at home.

On August 3rd of this year, we took Wilco to the vet for one last time but not before we took him down to the beach in Royston and for a little drive around town. I still think about him every day, remembering his goofiness. He loved the Royston beach and used to chase his ball there for as long as we’d throw it for him. He  and his ball were inseparable for the first seven years we had him.

 

After that, he lost interest, we suspect because he was in a lot of pain and it just wasn’t fun anymore. He even stopped chasing cats and rabbits about 18 months ago.

He was probably sixteen years old and couldn’t walk anymore. I had to carry him into the car and lift him out. The vet staff took him into the clinic. Our vet, Carol Champion checked him out and agreed with our decision to have him put down. A few minutes later, as he lay in his usual position on the floor she gave him a sedative. When she was certain he was sedated she injected him with what I think was pentobarbital. It took less than a minute and I noticed he wasn’t breathing anymore. I stroked his back a few times and gave him a pat on the head but he was gone. Carolyn and I were very upset but the staff at the clinic was super and so supportive. I find it very hard not to cry on these occasions so I just let it happen. I miss him a lot.

Having Wilco with us for 10 years or so, watching him with his ball, stalking the fish in the aquarium and chasing bears on the logging roads and on camping trips makes it hard to let him go. He was family.

I’ve said this before but I’ll say it again. If I’m in a lot of pain and immobile and as old as Wilco (relatively speaking) I’d be quite happy to die like he did, surrounded by caring people not willing to watch him suffer anymore.

After he was euthanized, he was taken to a pet crematorium somewhere north of Courtenay located on a working farm where he joined a number of other pets to be cremated together and have their ashes spread out on the fields.

Not all animals have the idyllic life Wilco lived, nor the peaceful, loving death. Of course every living thing is on a death trajectory. That’s no surprise. Essentially, living and dying are the same process. That’s one of the main reason we are so conflicted as a species around life and death. We fear life because we know it will bring us death. Our culture, our politics, our everything are aimed at eliminating threats, imagined or real,  to our ‘lives’. We insist that our deaths must be meaningful or we deny death altogether.

I’ll get into a long diatribe into the essence of life and death later, in another series of blog posts although you’ll find the archives in this blog full of references to death denial. Suffice it to say for now that life must consume life. Up to this time, life on this planet has been the mutual devouring of species. Can that change? Should we be more ‘humane’ in how we raise and kill other species for our own consumption? Does it matter how long a calf lives before it’s slaughtered for us? Does it matter how much pain and suffering we inflict on other species in the name of scientific research or simply to grace our dinner plates? Is life really just suffering? For now, I’ll just leave you with these questions. I may offer up answers, at least tentative ones, to these questions in future posts. Stay tuned.