There isn’t a lot of humor to be found in the infusion suite of a cancer hospital. But there was last Christmas Eve Day. I was there for a twice-a-week infusion, lasting two hours. The infusion stations are separated only by curtains, so I overhear a good many conversations (whether I wish to or not).
An elderly couple arrives.
Nurse: “Do you have family?”
Mom: “Two daughters.”
Nurse: “Oh, how nice!”
Pop:(Snorts.) “You think so, do you? What would you think of a 16-year-old girl who tells you she’s going to the library, but goes to the beach with her boyfriend?”
Mom:(With a satisfied air.) “She learned! She didn’t get her driver’s license till she was 18.”
Nurse: “What about the other one?”
Pop:(Snorts.) “What would you think about a high school girl who comes home from a date tipsy?”
Mom:(An even more satisfied air.) “She learned! She spent prom night at home with us, crying her eyes out.”
Nurse: “Oh. Well! How old are they now?”
Mom: “In their thirties.”
Nurse: “Are you going to see them for Christmas?”
Pop:(Snorts.) “You think they have time for us? For all we see of’em, they might as well live in China.”
Mom:(Sniffling, near tears.) “It’s our own fault, Ray. We spoiled those girls.”
If you’re afflicted, may 2018 be your year for a spontaneous, radical and miraculous remission! And if you’re a caregiver—I wish the same for your loved one, that your yoke will be lighter.
Do you know your statistical mortality? Do your best to forget it.
One day, science told me “You have until May 13, 2015, to live.”
I love science, trust science, studied it in college (chemistry), wrote about it for a living, and read it for leisure. It returned my devotion with that terrifying pronouncement.
Specifically, it was the science of statistics and probabilities that pronounced my mortality. My diagnosis was acute myelogenous leukemia. My prognosis (if chemo failed) was six months, or less.
But my reaction to statistical probabilities, then as now, is to stick two fingers in my ears and say “brblbrblbrblbrblbrbl,” until statistical probabilities stop talking.
Of course, I believe in statistical probabilities, just as I believe in pharmacology, which has helped me to survive AML for three years—uncured, but fairly vigorously. But in the applied science of medicine, there is enormous uncertainty; individual results vary broadly. The same chemotherapy knocks out one person’s cancer like it was jock itch, but fails the next guy. Statistics quantify the results on a bell curve, with a median mortality. That is the figure a doctor quotes when saying “you have six months, give or take.”
The reason they say “give or take” is because mortality statistics are both less than six months, or greater than six months. Possibly, far greater than six months.
A man who embraced statistical probabilities was the scientist Stephen Jay Gould. He was the Harvard evolutionary biologist and paleontologist who wrote such delightful, accessible books as The Panda’s Thumb and Hen’s Teeth and Horses’ Toes, both on my bookshelves. He was a people’s scientist, who even made a 1997 appearance on The Simpsons.
Mortality statistics go both ways; they are both less than six months, or greater than six months. Sometimes, far greater than six months.
Once diagnosed with peritoneal mesothelioma in 1982, he did what scientists do; he boned up on the research. He went to Harvard’s Countway medical library, to discover that the median survival for his incurable diagnosis was just eight short months.
He described sitting stunned for fifteen minutes; then, smiling.
If eight months was the median, then fully 50 percent with his diagnosis survived longer than eight months, some for decades. He in effect declared, “That will be me,” and it was: he survived for 20 years, lecturing at Harvard, and writing 300 consecutive essays for Natural History magazine between 1974 and 2001, never missing a month. That includes July 1982, when he was diagnosed. His post-diagnosis life was lengthy and well-lived.
He wrote a clever, hopeful piece for Discover magazine entitled The Median Isn’t the Message, describing his experience, and educating the reader on how to read statistics.
Death is not an appointment
To Gould’s thinking, those who accepted the median mortality were doomed to fulfill it.
Recall the old tale “The Appointment in Samarra”?
A merchant in Baghdad sends his servant to the marketplace. The servant returns, terrified, because he saw Death there. The merchant lends his horse to the servant, tells him “Flee to Samarra,” then storms down to the marketplace to confront Death. There, Death replies “I was astonished to see him in Baghdad, for I had an appointment with him tonight in Samarra.” (That from a 1933 telling of the tale by W. Somerset Maugham.)
A fine tale, the moral of which is, death is inevitable. Of course it is. But it is not predictable to the day. If I had accepted median mortality stats, I’d have been counting down the days to May 13, 2015, and making no plans beyond then; thus, putting a curse upon my life.
Gould would not be so cursed. He lamented the average person’s lack of training in statistics, saying:
I suspect that most people…would read such a statement as “I will probably be dead in eight months”—the very conclusion that must be avoided, since it isn’t so, and since attitude matters so much [italics mine].
So this scientist believed that mindset—“attitude”—affected your longevity. He went on to write:
Attitude clearly matters in fighting cancer…match people with the same cancer for age, class, health, socioeconomic status, and, in general, those with positive attitudes, with a strong will and purpose for living, with commitment to struggle, with an active response to aiding their own treatment and not just a passive acceptance of anything doctors say [italics mine], tend to live longer.
What, I ask you, is more fuzzy-edged, irreproducible, and less empirically quantifiable than attitude? And yet this scientist believed in it, as surely as he believed in statistics.*
You can adapt your mindset—quickly—to survive
The only pessimistic note in Gould’s article is that “one can’t reconstruct oneself at short notice and for a definite purpose.” He was referring to the temperament needed to survive cancer, believing you must have the right temperament in place before you are even diagnosed.
Respectfully—yes, we can adapt our mindsets, ASAP, when the stakes are life and death.
Witness the example of Viktor E. Frankl, who famously wrote:
Everything can be taken from a man but one thing: the last of human freedoms—the ability to choose one’s attitude in a given set of circumstances.
Frankl’s circumstances were those of an Austrian Jew imprisoned in three concentration camps, being Auschwitz, Kaufering and Türkheim. From that horrific experience was born his psychotherapeutic method, called logotherapy; to identify a purpose in life to feel positively about, then immersively imagine that outcome, until it becomes real.
Like surviving Auschwitz; like surviving cancer.
What those two circumstances have in common it is that they are sudden, horrific circumstances, visited upon ordinary people without preparation or a skills-set to meet them. I have no idea about Frankl’s temperament before his imprisonment. But his observation that “When we are no longer able to change a situation—we are challenged to change ourselves,” suggests that he adapted, radically and quickly.
He detailed his experience and theories in the book Man’s Search for Meaning, originally entitled …To Nevertheless Say ‘Yes’ to Life. He concluded that the average prisoner’s experience was based not solely upon experience, but also upon freedom of choice he exerts, even under severe suffering. He wrote:
Between stimulus and response there is a space. In that space is our power to choose our response. In our response lies our growth and our freedom.
Thus—to hope, in defiance of circumstance; and to choose a mindset, rather than have one (like victimhood) foist upon us.
Think you have an appointment with death? Break it.
Let no one convince you that hope is delusional, or anti-intellectual.
If you have learned and accepted your median mortality, then do your best to forget it. I’d have remained willfully ignorant of my own, if some tact-impaired smartphone scholar (you know the type) hadn’t Googled it and blurted it out. Still, I couldn’t un-hear that number, and as of this morning, I have survived the median mortality six times over ([3 years X 12 months]/6 months).
A quote I love is from the “Catholic Prayer to the Divine Physician”:
Destroy all the word curses that have been spoken against my health…I break every agreement that I have made with my sickness and disease.
That includes any “appointment with death” you have made. Looking back on my calendar at May 13, 2015, I skipped my appointment with The Pale Rider. Instead I turned in two articles to a client, then brushed the dog’s teeth. His breath was getting funky.
I have never counted how many days I (statistically speaking) had left. Instead I count the days I’ve survived since diagnosis, with tick marks in my journal; 1,096, as of this morning (3 years * 365 days + 1 Leap Year day). I expect many more days, months, years, because there are so many behind me; each day is a promise, God telling me “My will is that you remain where you are.”
Gould outlived his projected mortality by a factor of 30 ([20 years * 12 months]/8 months). When he succumbed in 2002, it was to a cancer unrelated to his mesothelioma. Frankl passed in 1997. Between them, we have two scientists who set store in hope—immeasurable, unquantifiable, unscientific hope. So, let no one convince you that hope is delusional, or anti-intellectual. It was good enough for these two smart guys.