You have no “date with death.”

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.

FranklSearchForMeaning
Viktor Frankl sought growth and meaning in the worst imaginable circumstance.

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.

CountingUpTheDays_small
I don’t find it useful wondering how many days I have left; rather, I count the days I’ve survived already, taking them as God’s promise that He means me to stay put.

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.

Godspeed.

* I covered pretty much the same list in my first entry, 1000 days of thriving with cancer. Here’s how. I was flattered to read Gould’s article months later to find much the same observations. You will find largely the same factors of survival at The Radical Remission Project.

When to say, “I do need support, but not yours.”

Forgive awkwardness, but shun toxicity.

When townfolk visit us at The Big C Ranch (my name for Brigham and Women’s Hospital), a little clumsiness is forgivable. We were flummoxed when we were diagnosed; so are they, and they try to comfort us in the best ways they know how.

Scheffer, Ary, 1795-1858; The Temptation of Christ
Jesus didn’t always “hate the sin but love the sinner.” Sometimes he commanded, “Get thee behind me.”

Our grandmas, bless’em, arrive with brimming pots still warm from their stoves. They don’t want to hear from smarty-pants doctor talk like “immunocompromised” and “outside contaminants.” Grandma keeps a clean kitchen, she knows what her ragazzino/bubeleh/niñito needs, and it’s her meatballs and gravy/matzo soup/chiles en nogada. She’s trying to save your life—nothing less.

Your humor’s a bit thin, but the “laughter is the best medicine” sort believes he’s helping when he jokes, “When your body hair grows back, you can brag about getting your pubes all over again! Aw c’mon! That was a good one!”

The scoffers mistake it for comfort when they belittle our modesty and senses of loss. They snort, wave a dismissive hand and say “It’s just hair! It’ll grow back!” Well, scoffer, if it’s “No big deal!” and I should “Just let them do it,” then let a nurse swab your damned rectum for C-Diff bacteria.

The malignant.

Nosferatu Bedside
“Don’t you worry,” soothe The Gatekeeper and the Chemo-Sabe. They will never leave your bedside.

A clumsy person may be forgiven; a malignant one must be shunned. We’re stocked up on malignancy, and I’ve observed six “supporters” who will drain the life from you, heedless of how short that life may be. (I wasn’t tasked by these pestilent six, but agonized while friends suffered them.)

The Ghoul thrills to the details of your suffering. How bad is the surgical scar? Does the chemo make you vomit? What’s the most embarrassing part of it all? “I only ask because I care,” but how long do you have to live? Would dearly like to see the blood clot the size of a baby’s finger that you sneezed up this morning.

The Smartest Guy in the Room undermines your confidence in your healers. He has their number. Lapses into stony silence whenever one of “them” (e.g., a nurse checking your vitals) enters your room. Sneers at Western Medicine and Big Pharma (crooked and in cahoots), but believes in cannabis and any cure that originated centuries ago, in India or eastward.

Forgive the clumsy, but shun the malignant. You’re stocked up on malignancy.

The Prodigal Father never paid child support, and missed your wedding. Learned about your cancer through the one cousin who still talks to him. But “I’m here now. And no one—especially That Mother of Yours—can say Joey Buttaroma doesn’t love his little girl.”

The Chemo-Sabe clings to you like Tonto to The Lone Ranger. Demands to know who visits you most often, and visits one time more. A gossip who won’t leave until you’re angry with someone else. Declares himself/herself shocked that Paul/Nancy/Carla/Phil hasn’t come to see you! But where Paul and Nancy have failed you, the Chemo-Sabe never will.

The Gatekeeper is often the sibling or cousin with whom you got along least. But she’s here now, to protect you from everyone else (“She needs her rest, so no one gets to her unless it’s through me. That goes for even you, Ma.”). Insists “You and meWe’re gonna beat this thing, together.”

The Serpent offers to sneak in wine, a Subway foot-long BLT, marijuana in brownies, because “You’ve been through Hell, you deserve it!” Never mind the life-threatening risks of salmonella or drug interactions—“Doctors have to tell you that stuff.” Will take you straight to a bar to “cut loose” once you’re released. Like The Gatekeeper, tries to get between you and others (viz., “Don’t tell that judgmental brother of yours, he doesn’t know how to live”).

You’re in need, but they are needier.

“It’s not your blood they drain; it’s your emotional energy,” wrote Dr. Albert J. Bernstein, who reckoned demons like these in his 2001/2012 book Emotional Vampires: Dealing with People Who Drain You Dry.

What do they need from you?

  • The Ghoul seeks the kind of thrills that can only be got from human suffering. May not be a sociopath, but has all the sensitivity of one. Will lose interest in you when you are cured.
  • The Smartest Guy in the Room needs you to acknowledge his superiority, even in a hospital like Brigham and Women’s surrounded by healers who never got an A-.
  • The Prodigal Father needs your validation that he hasn’t failed as a parent, which only you can grant. He’ll then wave that knowledge under the nose of That Mother of Yours.
  • The Chemo-Sabe is likely awkward, friendless, and you are a zoo animal that she can visit at will.
  • The Gatekeeper’s devotion to you proves his/her value to those who (often rightly) question it.
  • The Serpent is usually a sociopath, bent on punishing you for the sin of courage, or for pulling attention.

They likely mistake their ill intent for good, as the emotional vampire is usually an horrendously poor self-observer.

Strategies to protect yourself.

Ask yourself simply, whose visits do you anticipate, and whose do you dread? Make a two-column list, and be merciless. Only you will read it.

Whose visits do you anticipate? And whose do you dread?

Having discerned between the two, there are several actions you can take:

  • Surrender your need to please. Easier to say than to do. But The Ghoul, The Prodigal Father and The Serpent have no feelings to hurt.
  • Tell them, “Please don’t come, I need to rest.” This is no lie. You do need rest, and visits from The Ghoul and Chemo-Sabe aren’t restful.
  • If you are unassertive, enlist someone who is. Perhaps in your emotionally wrung-out state, you can’t bring yourself to confront The Gatekeeper by saying “You’re not in charge of who sees me, I am.” Then ask your warhead of a sister/brother/best friend/mom/spouse to say it for you. They’d be delighted.
  • Enlist your nurses as bouncers. They are charged with your wellbeing—physical and emotional. Tell them, simply, “I’m expecting my parents today; please don’t admit anyone else.”

Jeez, isn’t that really judgmental?

No. It is discernment. Surrounding yourself with healing energy, and protecting yourself when you must.

As a kid, did a friend give you your first cigarette? Sneak a Budweiser out of your dad’s six-pack? Maybe get you to shoplift? Your parents likely demanded you drop that friend. They didn’t wast time “hating the sin, but loving the sinner.” Their child was imperiled, and they acted. They let God sort out the sinner.

That is discernment, and both the Old Testament and New teach us to protect ourselves from the ill-meant:

  • “And whosoever will not receive you, when ye go out of that city, shake off the very dust from your feet for a testimony against them.” (Luke 9:5.) Jesus taught, if you are not heard—and these six are deaf to what you truly need—then disengage.
  • “I have not sat with vain persons, neither will I go in with dissemblers.” (Psalm 26:4.) Dissemblers are liars, and “dis-assemblers” who come between you and others.
  • “He that goeth about as a talebearer revealeth secrets: therefore meddle not with him that flattereth with his lips.” (Proverbs 20:19.) A gossip, like the Chemo-Sabe, is a talebearer.
  • “Avoid profane and vain babblings, and oppositions of [knowledge] falsely so called.” (1 Timothy 6:20.) This applies to The Smartest Guy in the Room, especially, who wants to shake your faith in your treatment.
  • “But shun profane and vain babblings: for they will increase unto more ungodliness.” (2 Timothy 2:16.) Simply put, shut down a liar, dissembler or gossip immediately; your further corruption is their joy.

You have the permission of Christ, King David, King Solomon and the Apostle Paul to protect yourself.

With the chaff sorted out, we are left with the wheat; those whose visits leave us feeling energized, optimistic, healed. On my list “Lifts My Spirits” were my parents, my Sadie Mae, her magnificent brothers and their wives, alongside my old pals Bill, Erik and Frank.

There were but two names on my list “Leaves Me Drained,” each with the same flaw—a mean temper. After her latest tantrum, over grammar (she teaches writing at a university), I definitively told one, “Do not visit, do not phone, and I’ll update you if I survive.” I repent of my sarcasm. But I’d been trapped alive in the Big C bunkhouse for a seven-week round of chemo, with almost four weeks to go, and no guarantee of survival.

Those are the stakes, no less. We need our depleted energy for survival. I wouldn’t risk a minute of life with Sadie Mae, arguing with someone else if “thusly” is a word.

You have the permission of Christ, King David, King Solomon and the Apostle Paul to protect yourself from emotional vampires. Please, do. Trust in God; He’ll sort’em out.

Godspeed.