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Jan 19

“History doesn’t repeat itself, but it often rhymes,” Mark Twain is supposed to have said.

He was right, but he wasn’t saying anything new, as anyone familiar with the Bible can attest.

In Ecclesiastes you will find, as ancient precursor to Twain’s observation, this axiom from King Solomon:

What has been will be again, what has been done will be done again; there is nothing new under the sun.

Solomon’s words surfaced in my mind on New Year's Eve as the last hours of 2018 bled away.  I stared glumly into the bathroom mirror at yet another volcanic eruption studding my 51-year-old mug, echoes of my pimply-faced adolescence ping-ponging in my brain.  Zits don’t ordinarily occupy the same territory as hard-won wrinkles - nor should one ever need reading glasses to properly inspect them.

I have my oncologist to thank for this acned absurdity.  One year ago, as 2018 rose unsteadily from the ashes of 2017, the stubborn beast of a cancer in my head reincarnated itself alongside the new year, thumbing its nose at all previous efforts to slay it.  I wasn’t keen to risk another craniotomy after four mighty kicks at that can; I’m all for being “open-minded”, but preferably not surgically.  So, after lengthy discussion with my cancer specialist, I took a flyer on a novel drug, armed with lotions and potions to keep the inevitable side effects at bay.

Wondrously, affront to my dermatological vanity aside, the concoction appears to be working.  A year later, and a dozen years after the initial shock of diagnosis - twelve years after I stared for the first time at MRI images of a malignant octopus strangling my brainstem, cancerous tentacles thrust deep into my grey matter - I’m still here, and reasonably functional to boot.

In 2007, in the grim language of this business, I was “given” seven years to live - that being the average length of survival for those with my sort of cancer, my own case more serious than most.  And yet I’m still breathing.  Which serves, if nothing else, to illustrate the foolishness of that language, nonsensical bunk that should be buried in place of the patients it threatens.

Because time is not something that any doctor can “give”.

A diligent physician confronted by a shell-shocked patient asking, “How long do I have?” does and should provide guidance and insight, based on what evidence exists.  It’s important for patients to be acquainted as much as possible with the landscape of one’s illness. But too often that useful information is absorbed in those traumatic moments as: “The doctor gave me ‘X’ years to live.”  Which is patently ridiculous: every patient is different and every patient’s illness is different.  Prognosticating individual survival times is an educated guess at best - and wildly wrong at worst.

Consider, as example, the case of famed astrophysicist Stephen Hawking.  Diagnosed with Lou Gehrig’s disease as a 21-year-old student at Oxford, he was “given” two years to live.  He died last spring, fifty-five years later, at the ripe old age of 76.

Rivers of ink were spilled in the aftermath of his departure, celebrating the stupendous accomplishments of this brilliant man who plumbed the depth and breadth of the cosmos.  Column after column lauded his tenacity in overcoming his death sentence and proving his doctors wrong.  “The world is unquestionably better for their error”, read an editorial in the Globe and Mail.

But his doctors did not err.  Their diagnosis was correct: Hawking had Lou Gehrig’s disease – amyotrophic lateral sclerosis, or ALS.  On average, patients with ALS die within two or three years, a sad metric that hasn’t changed all that much in the decades since Hawking got tagged.  But the disease is variable: more than half of those diagnosed with ALS live for more than three years.

Hawking happened to be afflicted with a particularly slow-moving version of the disease; and that fact, joined to his willingness to tolerate living with tremendous physical disability, served to elongate his “brief history of time” on this earth to its seemingly extraordinary length.  While his life was unquestionably extraordinary, the span of it was not: his disease was simply his disease.  His intellect was unparalleled, his resilience incredible, his accomplishments other-worldly; but Hawking could no more take credit for the slow progression of his illness than anyone else can take credit for not being stricken with ALS in the first place.

It’s important to emphasize here the glaringly obvious: averages cut both ways. Many individuals diagnosed with ALS don’t make it to two or three years, and to suggest that they are less endowed with grit and tenacity than Stephen Hawking is to do them and their memories and their loved ones a profound disservice.

The same is true for any other terminal condition: many people don’t “make the number” they are “given” despite marshaling all of their resources to remain among the living.  In the end, no matter how mightily one resists, one’s disease is simply one’s disease.  During my own odyssey I've come to know numerous individuals battling the same rare cancer as my own; some have lived far longer than I, but many have succumbed to the Reaper long before their “seven-year sentence” is up.  You can fight like a cornered bobcat to survive - but you don’t get to pick your opponent.  “Life is like a box of chocolates,” said Forrest Gump, “You never know what you’re gonna get.”

When Arizona senator John McCain lost his battle with glioblastoma last August, four days before his 82nd birthday, rivers of ink again issued forth to commemorate another remarkable soul.  Among the torrent of commentary were some pieces lamenting the military jargon used to describe McCain’s last stand.  “Martial language propagates the dangerous myth that death is the result of a personal failure to fight hard enough,” said one prominent physician.

But that too is nonsense.  Take it from one who knows.  It’s all-out war - and there’s no shame in fighting the good fight only to lose the battle.  Battlefields have always been littered with the fallen, warriors no less valiant and no less worthy for having fought and died.

McCain, as most anyone knows, spent more than five years as a POW in North Vietnam, captured after breaking both arms and a leg bailing out of his plane when it was shot down during a bombing run over Hanoi in 1967.  Despite horrific deprivation and years of torture, he survived by dint of tenacity, faith and good fortune. But many of his fellow POWs did not – and they possessed resilience, courage, and faith in no less measure than McCain.  To his great credit, McCain never forgot how blessed he was to survive, and rendered his gratitude for the rest of his days in singular service to his country.

I sat among thousands of others a few years ago listening to Nick Vujicic, the inspirational founder of Attitude is Altitude.  Born with no arms and no legs, Nick suffered enormously in his early life, physically and especially psychologically.  After describing his journey, after detailing the bullying, the suicide attempts, the hardships, and the distillation of all that pain into the man he has become, Nick looked out at his audience and asked: “What about you?  What’s your problem?  Why are you living?”

Why are you living?

It’s a great question.  And life is full of great questions: “Judge a man by his questions rather than by his answers,” advised Voltaire.  When I was confronted with cancer at the age of 39, my “great question”, a plaintive cry hardly unique to my circumstance, was: “Why me?  Why me, God?”

It’s a question mostly asked in the negative, rarely the positive.  I had never asked, for instance: “Why me?  Why was I born in Canada, one of the richest countries on earth, to parents who cared deeply for me and gave me every opportunity to succeed?  Why am I blessed with healthy children and a wife who loves me?  Why am I so fortunate as to have access to the very best medical care in the world?”

“Why not me?” coupled with “Why am I living?” would be the healthier, balanced response to life’s tough challenges, needless to say.

I came across an absurd comment at the time of Stephen Hawking’s passing: “He lived his entire life with a death sentence.”  I thought in reaction: “Don’t we all?  Isn’t the leading cause of death being born in the first place?”

It may seem a bit of a downer, dear reader, to point this out - but you are dying, too.  All doctors lose 100% of their patients in the end.  It’s simply a question of when.

Along the way to that day many of us become as intimately acquainted with the adversities of life as were McCain and Hawking and Vujicic, just as aware of its excruciating detours and agonizing setbacks and bleak wilderness experiences.  But as those three men have shown by their shining examples, the surest blueprint to mining life’s riches is to navigate bravely through the darkest of times and to stubbornly scale the obstacles that arise, no matter how steep.  And living life to its fullest requires far more than simply surviving.

“When the great oak is straining in the wind,” wrote Edwin Markham, “The boughs drink in new beauty, and the trunk sends down a deeper root on the windward side.”

“However difficult life may seem,” said Stephen Hawking, “there is always something you can do and succeed at.  It matters that you don’t give up.”

“But I’m no John McCain," I can hear some of you saying.  Consider this:  as a young man in the United States Naval Academy, John McCain graduated fifth from the bottom of his class, 895th out of 899 midshipmen.  He didn’t seem destined for greatness, suffice it to say.  Yet behold what became of his life, shaped as it was by the crucible of his harshest experiences.

As any student of literature knows, the most famous work of Welsh poet Dylan Thomas is his rant against death:

Do not go gentle into that good night,
Old age should burn and rave at close of day;
Rage, rage against the dying of the light.

For most of my readers, happily, the sun is still shining brightly as you tend to life's gardens.  But it shall not always be so.  Your time of departure will come, and when it does, whether you be old or young or middle-aged - when the shadows lengthen, as the sun of your vitality is lowering, its rays bleeding inevitably into mortality’s horizon – then you may rage, if you choose, against the dying of the light.

But my sincere wish for you is that you won’t.  There’s far too much rage in our world.  I hope when your time comes that you, like John McCain after a life well-spent, can go calmly and gently into that good night.

Those final moments remain for most of us far distant.  But it’s not the length of the time we get to spend on this planet that matters the most – it’s what we do with the time that we're given.  Young or old, pimply or not, our challenge is to look squarely in the mirror every single day and ask ourselves this question:

Why?

Why are you living?

6 Responses for "It's 2019: Why Are You Living?"

  1. Kervin says:

    A sobering and sintilating word that does not leave us where us it found us! Thank you Dr. Ed.

  2. chris says:

    today is the first day of the rest of my life. therefore will i “fish!”

  3. Adriane says:

    Ed,

    May your words reach many and settle in and take hold- You have posed the question near and dear to me and it is -each day -paired with a gratitude I can willingly and am able to positively impact the communities in which I live. Here’s to living each day with intention. Thank you for sharing your wisdom again and again. Love, Adriane

  4. Each day is a gift, use it wisely...thanks for the reminder Ed.

  5. Jo-Ann DuFeu says:

    Thank you for reminding us that we should try to make every day as special as possible. So well written.

  6. Nancy D says:

    Thank you so much for this article as well as others. I really do appreciate your work.

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