Christopher Hitchens, the writer, journalist and polemicist, died in December 2011. He was taken ill on the morning of the day on which he was due to appear on The Daily Show with Jon Stewart, to promote a new book. The severe chest pain that he thought was due to a heart attack was in fact a manifestation of oesophageal cancer. He was soon told that the disease was metastatic, and he began to write about his thoughts and experiences. These writings were collected into a book called Mortality. I picked it up the other day and read it in an hour – it is highly recommend. He describes what happens when you are taken ‘from the country of the well across the stark frontier that marks off the land of malady.’ As an ardent and argumentative atheist he takes a good pop at religion, but in this article I would like to highlight the paragraphs that made me think twice as a clinician. There are numerous observations that will stick with me as I meet other terminally ill patients, and I think all healthcare providers would benefit from reading them – from phlebotomists to ‘proton doctors’. I have organised some of them into categories of my own making.
On arriving in the land of malady, or ‘Tumorville’
The new land is quite welcoming in its way. Everybody smiles encouraging and there appears to be absolutely no racism
The country has a language – a lingua franca that manages to be both dull and difficult and that contains names like Ondansetron for anti-nausea medication.
In her famous essay on Hollywood, Pauline Kael described it as a place where you could die of encouragement. That may still be true of Tinseltown; in Tumortown you sometimes feel that you may expire from sheer advice.
Like so many of life’s varieties of experience, the novelty of a diagnosis of malignant cancer has a tendency to wear off.
On being terminally ill
…I am badly oppressed by the gnawing sense of waste.
To the dumb question “why me?” the cosmos barely bothers to return the reply “why not?”
The absorbing fact about being mortally sick is that you spend a good deal of time preparing yourself to die with some modicum of stoicism (and provision for loved ones), while being simultaneously and highly interested in the business of survival.
On cancer treatment and ‘the battle’
It also involves confronting one of the most appealing clichés in our language. You’ve heard it all right. People don’t have cancer: they are reported to be battling cancer.
The oncology bargain is that in return for at least the chance of a few more useful years you agree to submit to chemotherapy and then, if you’re lucky with that, to radiation or even surgery. So here’s the wager: You stick around for a bit, but in return we are going to do going to need some things from you. These may include your taste buds, your ability to concentrate, your ability to digest, and the hair on your head.
Brave? Hah! Save it for a fight you can run away from.
Allow me to inform you, though, that when you sit in a room with a set of other finalists, and kindly people bring a large transparent bag of poison and plug it in your arm, and you either read or you don’t read a book while the venom sack gradually empties itself into your system, the image of the ardent soldier or revolutionary is the very last one that will occur to you. You feel swamped with passivity and impotence: dissolving in powerlessness like a sugar lump in water.
On the etiquette of illness
In truth, if you can’t bring me news about that [his particular tumour] and that alone, and about what happens when lymph nodes and lung may be involved, I’m not all that interested or all that knowledgeable. One develops a kind of elitism about the uniqueness of one’s own personal disorder.
As it happened he was exactly right to ask, but it had been precisely that which had been bothering me, and I was unreasonably shocked by his bluntness. I’ll do the facing of hard facts, thanks. Don’t you be doing it too.
But again there was the unreasonable urge to have a kind of monopoly on, or sort of veto over, what was actually sayable. Cancer victimhood contains a permanent temptation to be self-centred and even solipsistic.
On carrying on
And timing is everything: the exquisite moment when one can break in and cap a story, or turn a line for a laugh, or ridicule an opponent. I lived for moments like that. Now if I want to enter a conversation, I have to attract attention in some other way, and live with the awful fact that people are then listening “sympathetically.”
My chief consolation in this year of living dyingly has been the presence of friends.
I can’t eat or drink for pleasure anymore…
Before I was diagnosed with oesophageal cancer a year and a half ago, I rather jauntily told the readers of my memoirs that when faced with extinction I wanted to be fully conscious and awake, in order to “do” death in the active and not the passive sense. And I do, still, try to nurture that little flame of curiosity and defiance…
On the burden of treatment
Towards the end of his long life [the late Professor Sidney Hook] became seriously ill and began to reflect on the paradox that [ ] he was able to avail himself of a historically unprecedented level of care, while at the same time being exposed to a degree of suffering previous generations might not have been able to afford.
…he used a potent phrase to describe the position of others who suffer like this, referring to them as lying on “mattress graves”…
So we are left with something quite unusual in the annals of unsentimental approaches to extinction: not the wish to die with dignity by the desire to have died.
I wondered if things looked as red and inflamed within as they did without. And then I had an unprompted rogue thought: If I have been told about all this in advance, would I have opted for the treatment? There were several moment as I bucked and writhed and gasped and cursed when I seriously doubt it stop
It’s probably a merciful thing the pain is impossible to describe from memory. It’s also impossible to warn against.
But mercifully, too, I can’t summon the memory of how I felt during those lacerating days and nights.
To shrink at the thought that I am only a wrinkle or twist away from severe fear or “distress” (a word quite high on the euphemism scale.)
On blood tests
For years I found it absurdly easy to undergo routine blood tests. I would walk in, sit down, endure a brief squeeze from a tourniquet…
…one had to stop pretending that the business was effectively painless. It doesn’t hurt that much having the needle inserted for a second time. No, what hurts is having it moved to and fro, in the hope that it can properly penetrate the vein and release the needful fluid.
Please believe me when I say that one quickly comes to sympathise with the technicians. They are proud of their work, and do not enjoy imposing “discomfort”. Indeed, they were regularly and with relief give place to another volunteer or submit to another’s expertise.
It can’t have been much less than two hours until, having tried and failed with both arms, I was lying between two bed pads that were liberally laced with dried or clotting blood. The upset of the nurse was palpable…when the technician would offer to stop, I would urge her to go on and assure her that I sympathised.
Painting from the website Paintings on the Side by Cara & Louie