Postscript: Five Years Later: The Final Cut
Posted by Andrew | Filed under Cancer Diary, Commentary, General, Health, Humour, Living in Korea, Uncategorized
One of the involvements that I have been having recently, as part of a burgeoning interest in Stoicism as a philosophy of life, is of writing my reflections upon a question or proposition twice a day; the practice of Stoic (reflective) journalling. Twice a day, I record my responses to philosophical cues from Ryan Holiday’s “Daily Stoic Journal”, although not without gaps at present.
Philosophy, however, represents a reflective space, which can be highly personal, where the strands of one’s life can converge with new ideas, and in which new ideas can be introduced; and in this environment, the worth of those ideas can be compared. This is where the Journal comes in.
Here, finally, then, with something of a Stoic background, I am thinking about the post-experiential recollection and response to a health issue long after the event, essentially bringing my cancer narrative to a close. When they give you the Bad News, how should one respond? Is cancer cause for humour?
Tumour humour, much?
After some five years of completing the post-operative monitoring and being essentially cleared of cancer last December (with the obligatory you-know-what stuffed up my posterior), I recently found myself considering an odd question, late at night (well, I was lying in bed at the time, what a surprise!): after all, the cancer was not, and could not be, the only bad or stressful experience that I would face in my life. Also, I had recently passed the age of sixty, and despite the fact that since that time, I had been put on some half a dozen drugs for my blood pressure, biologically, at least, I seemed to be sound and stable – or, at least, as “sound and stable” as one might be, taking half a dozen drugs a day… it sounds worse than it really is. Really.
However, this led me to ask myself the question: years later, when a life-threatening condition would be in the increasingly remote past, how should I look back and react to it? An analogy might be with the kind of “gallows humour” one encounters among people who have dangerous occupations; some levity, however odd, relieves at least a little of the immediate stress.
Obviously, when I was first told that I had bowel cancer, considered to be a high risk, I was not exactly overjoyed: I had had a sudden, intense existential threat thrust into my face, and perhaps I need not suggest here how great the shock factor might be. The days immediately thereafter, when everyone around me was getting on with his or her own life basically as normal, seemed somewhat surreal. In much the same way that young people talk about death as a strange and remote thing, I had always thought of cancer as something that was unlikely to happen to me, yet here it was. Be warned, people: cancer strikes fifty per cent. of us before we finally kick the jolly old bucket. It could be you… actually, it probably will be.
Now… as I have become increasingly involved with considerations of Stoic philosophy recently, this suddenly came to the forefront of my thinking, as it seems to parallel the notion that emotional reactions to external stimuli are not necessarily appropriate, if only because most things in life are deemed by many mature people as not being worthy of comment. It is, to be honest, hard to not recall these things sometimes, as the human mind has a habit of recycling ideas and experiences, but there are definite benefits, as this helps to guard against forgetfulness. We should, however, remember this golden rule: not everything you see in life is worthy of comment. Learn, instead, to laugh inside with maybe a wry smile to yourself. Laughter will always take away some of your own stress. Don’t try to share it with or explain it to others, as they will probably take it in the wrong sense, and you may even find yourself ostracised as a result. People are funny like that; there are too many strange (or otherwise bizarrely self-indulgent and narcissistic) people in society.
Stress itself is a known cause (or contributory factor) of cancer, and we can hardly suggest that daily life is lacking in stressful elements – if you are foolish enough to have the TV on for any length of time, the news media (which you actually pay for, back in the UK), is non-stop stressful propaganda. I sometimes feel that people could get cancer just from too much time spent immobile watching the goggle box. No kidding! The bullshit is both constant and unbearable; the most sensible thing to do is turn it off. Hence, very often here in Korea, as I try to get new apartments of the unfurnished variety and do not have a television of my own, I will simply get the Internet hooked up and not worry about it. I will choose what pabulum my mind should receive, thank you very much. Some unfurnished apartments, like the current one, may come with a TV, but I basically ignore it.
TV needs to be avoided because it is populated by a strange caste of narcissists, and these are also a group who should be excluded from your life, as their presence is a great source of stress. Especially if one of these is someone you actually admire, ask yourself whether what they do presents a realistic or even acceptable example of social behaviour. Also, does their behaviour or attitude represent a benefit to wider society? Probably not. Sadly, our civilisation has begun on its downward slope and we are about to witness a huge decline and fall. The narcissists are a parasitic class who produce little of value (but typically value themselves and their opinions rather highly, so go figure), but slowly burden society down until it is unable to rise again, like ticks infesting an old pasture horse until it suddenly drops dead. Turn off the TV and keep them out of your living room. Their dubious doings are no concern of yours.
When it comes to philosophy, Stoicism is too often regarded as encouraging an attitude of detachment and possibly even emotionlessness in the face of what many would call suffering or misfortune, but in reality, the original Stoics were people who rejoiced in life; despite the bad experiences that they encountered, the Stoics asked themselves what they were (or should be) grateful for; was life completely bad, or did they still have things which were good, which they should remember even as the misfortune was perhaps upon them? The popular perception of Stoicism is incorrect, and is the result of ignorance.
When we remember the origins of Stoicism with the death of Socrates, the reactions of his admirers and followers and, indeed, the passage of Stoic philosophy through generations of thinkers such as Marcus Aurelius, we need to remember that the backdrop to their experience of daily life, of what it meant to be human, was in a world very different from the world we know today. There was undeniably a greater opportunity for suffering in a society with not only slavery and plebeian poverty but also a culture in which punishment was often almost synonymous with entertainment; also, reading Suetonius’ account of the lives of the Caesars makes it very clear that being in a position of privilege or wealth in ancient Rome was no real defence against either persecution or sudden death.
Life in those days required a certain amount of fortitude simply to exist and survive in a world where death could come at any moment, whether at the hands of an interlocutor with ill intent or due to the relatively primitive state of medicine; as history shows, even the emperors of Rome were not immune, as even their own bodyguards could turn on them at a moment’s notice. Ancient societies necessarily persisted at the point of the sword, infant mortality was high and they did not have the advantage of such things as antibiotics in the event of diseases. Since life could be snatched away in an instant, people needed not only to live in the moment, but also to reflect upon whether they were actually making good use of their time and having good plans for an uncertain future. When a Stoic spoke about “gratitude”, you can be sure that at least part of what they were grateful for was the simple joy of being able to wake up the next morning to experience another additional day of being alive. Ironically, the main threat to the original Stoics was that they were misperceived as seditious malcontents, when in fact they were more concerned with how a good life could be lived.
As the ultimate origin of what we now call “Stoicism” was with Socrates, let’s not forget what was probably his most important assertion: that an unexamined life was not worth living. When we are confronted with the Bad News, perhaps, in a Socratic vein, we should be asking ourselves what kind of lessons we will have learned in its aftermath, when we have the opportunity of a post-experiential examination of what happened, and how it should inform our thinking in the future. Socrates would probably berate us as contemptible fools, destined to live our lives in suffering and ignorance, if we took little or no time to consider the lessons that the experience had brought us.
In a developed modern society, surrounded by the products of advanced technology and medicine, it is perhaps too easy to fall into the illusion of a kind of virtual immortality; indeed, so many of us seem to live as if we think death will never come. The ancient Romans knew this, and their watchword was “memento mori”: “remember that you must die”. We are all mortal and irrespective of our individual desires or intentions, death is something that we must all face in the end. In such circumstances, there is at the same time not only irony in laughing at past misfortunes, but also optimism in the realisation that we were strong enough to endure them. Paradoxically, perhaps, the experience also gives us strength and hope when other misfortunes strike – experience which we can share with others when they are likewise affected. It was hard when the crisis was upon us, but the outcome was that we discovered what strength we could summon up from deep within ourselves when we needed it most. What we discovered was, in fact, that we had more strength than we ever imagined; strength such as is difficult to explain to others. The medicine and science are great and all, but without an appropriate Socratic self-examination after the fact, perhaps, nothing would have been learned.
It is not without reason that we speak of “cancer survivors”, even with the benefits of modern medical technology, but unfortunately, we cannot avoid the inevitable. In the twenty-one years since I left the UK, the older members of my extended family have also been passing to the great beyond, something that I could not fail to notice; medicine can only take us so far before biology strikes. They did not all die of cancer, but due to a range of the afflictions of old age. We must learn to see these things as signals from the future; yes, the passing of our friends and family is always deeply saddening, but in the face of that which cannot be avoided, perhaps we should be celebrating the achievements by which they will be remembered. The mourning itself passes eventually, and they live on in the memories of those who survive them. However, we all go the same way, in the end. Memento mori.
At the time, when my own cancer was diagnosed, I had no idea what would happen in the period of days leading up to the operation, or indeed whether the actual end was looming. I shared a very small ward space with six other male patients who were at different stages of progression. As smoking is still very prevalent in Korea, there was no doubt in my mind that this was responsible for the condition in at least some of my temporary cohabitees, and with some of them, the progression was clearly advanced and it was affecting their minds. Outside, the weather was cold, as it was now early January, and as I was waiting to have my operation, I would watch the snow falling past the ward window, which was a strange contrast with the surprisingly high temperature that was maintained indoors, and which kept me constantly sweaty. [1] Of course, a single room was possible, but I was told that the cost was some KRW450,000 a night, so that decision was kind of already made for me… the others would simply have to put up with my snoring…
One might also comment that there is an element of fatalism in abandoning oneself to whatever is to come, yet assenting to an operation is not a guarantee of survival. We place our trust in the surgeon, but there is no absolute certainty of returning alive from anaesthesia; some abandonment and casting oneself upon the seas of fate is a requirement in such circumstances, not a choice. As it happens, the operation proceeded as planned and I was transported back to my bed with a load of catheters and cannulae inserted at various points (not to mention the Fecal Diversion Device itself), which rather hampered both easy movement and routine hygiene; but I persisted. It seemed the right thing to do at the time…
Over five years after the event, I find myself often reflecting upon that brief encounter with mortality with varying amounts of humour, sometimes rather dark, maybe still maintaining the typical human delusion in my mind of immortality, even as the reality creeps ever closer, considering that I have now reached the age of sixty. However, it is because I made a choice that I am able to sit here, typing this on my tablet; and because I made that choice, and did not succumb to a kind of paralytic indecision at a moment when mortality beckoned, I am free to continue my life as I wish, at least, for as long as it lasts. Perhaps this is, in fact, the most important take-away from the experience: it’s not the odd humour itself but the surviving and being able to indulge in the humour, because without the former, the latter is impossible. Socrates was right; you learned something there.
What, then, can I offer by way of advice to anyone who has such a circumstance thrust upon them?
Firstly, let me express due gratitude to Professor Kim Jae-hwang, the surgeon, his team, and the ladies and gentlemen on the ward, who all put up with an odd foreigner with grace and dignity. Secondly, let me express my gratitude to my ex-manager at Times Media, Jamie, who did not hesitate to get me to an initial specialist’s examination when the symptoms became severe. Let me, thirdly, express my gratitude to another lady who stepped in to countersign the necessary forms when another had promised to do so, but did not turn up as agreed. I need not mention her name here, but her signature was probably the most vital component in all of this.
My final advice might be something like this: survival is manifested as a consequence of many things, many factors, perhaps many choices, but when mortality calls, you must make the decision, and don’t be afraid. If the price of your indecision is death, it is still a choice that you must make; as we saw above, greater minds than yours have been taxed by similar situations in times past, and did not waste time on it. They were no more welcoming of the inevitable than you, but understood that they were free to choose; and what followed from their choices became history. Moral (perhaps): make the right choice, and maybe you won’t be history…
… you want to be able to look back, many years later, and laugh; recalling that time when death came to call, and was denied…
… and be grateful.
References:
[1] In fact, I had to collect my urine each time I went to relive myself, as they were monitoring this output. The trouble, of course, was that I was sweating so much that this would distort any figures that they were calculating.
