Reading the amazing, heartbreaking book ‘When Breath Becomes Air’ by Paul Kalinithi has made me think about the concept of time in relation to an advanced cancer diagnosis.
I’ll be coming up for my one-year-diagnosis-anniversary in a couple of months (woo-hoo bring out the bunting!), and having withstood a course of chemo over the Autumn-Winter, maintained a pleasing level of general health, fitness and wellbeing, and having now finished a course of RT… I’m thinking: what next?
Is the reality of living with cancer an existence of treatments, scans and blood tests interspersed with, you know, actually trying to live a life? Or is your life interrupted, slowed or paused by a series of treatments, scans and blood tests?
We say ‘don’t wish your life away’ but it is difficult to stop yourself from thinking ahead to the next scan or blood test when those very things can dictate your future, and how much of it you might have left to experience.
One of many memorable scenes from ‘When Breath Becomes Air’ is the writer’s first meeting with his oncologist. The said oncologist refuses to give a prognosis. Kalanithi persists with his request in future meetings but the response is always the same: absolutely not. The frustrated writer reasons thus - “if I have 6 months, I’ll spend it with family. If I have a year, I’ll write a book. If I have ten years, I’ll carry on working as a neurosurgeon”. It’s all very well bringing out the cliched old platitudes of ‘live one day at a time’ and ‘live each day as if it is your last’, but that doesn’t get your life really lived. It doesn’t get exciting events planned or holidays booked, parents visited and online shopping arriving when you’ll actually be in the house. Unless of course, you never leave your house. But with a generous dose of innate optimism and current decent health, I - like Kalanithi - want to be able to ‘do stuff’. And that means a need to plan ahead to a certain extent.
So let’s invite our special guest to this philosophical musing; Old Father Time. (The wily old bastard). I’ve come across a few different mindsets, or ideologies - call them what you will - when it comes to viewing time when living with incurable cancer. You can draw up a bucket list and work your way through as much of it as you can (if you have the funds). You can adopt an attitude of defiance and live your life as you would anyway for as long as possible. You can ease off on your commitments and focus on spending quality time with family, friends and loved ones. But surely these attitudes align with how much time you have - it would take a certain type of person to reject spending more time with those closest to them in favour of ‘business as usual’ and the 9 to 5 grind of work if they only have several months to live? One’s health must also be a factor; any bucket list is going to be relatively short if you are confined to a house or even a bed. Perhaps the best response is to do a combination of the above options, but again, the snag is that when you feel the hot breath of Old Father Time down your neck, how do you know if you are spending the ‘right’ amount of time on the ‘right’ things?
Part of Paul Kalanithi’s goal after he has been diagnosed is to live a life of meaning. It is interesting to consider what people think has been meaningful or not about their lives when, as an elderly person, they cast their minds back to give their existence an overview and to mull over their choices. It is a given, for example, that no-one ever thinks ‘I should have spent more time at work’. In an article I read about this, alongside the regret of having spent too much time working were the regrets of not allowing oneself to be happy and not living a life true to oneself. It strikes me that amongst a number of factors which feed into people’s decisions and choices as the treadmill of life turns relentlessly under our feet is the factor of time. We are excellent at putting things off and prevaricating. When we know that we should have 70, 80, 90 years to play around with (and statistically speaking, most of us do), urgency and upheaval can seem reckless and opting for comfort and familiarity is often our default. Why risk a big change of job, location or relationship when things are going ok, and might even improve and develop given time? I believe the regret about not allowing oneself to be happy is more about missed opportunities than an unhappy life per se. If you look back to a point when you wished you did something differently, this is pretty clear evidence that you really should have.
Perhaps a life of meaning, then, is a life of no regrets? Perhaps when we are confronted with the true fleeting nature of time - by a cancer diagnosis, for example - we immediately reflect on who we really are, what we really want and what really makes us happy? Because there would not be much point in lying to ourselves at this stage…
This brings me back to how to best use this precious time that we have in a way that feels meaningful. My hunch is that we should plan with some guardedness but be spontaneous with optimism. Have things to look forward to in the near-to-medium future and throw ourselves into anything fun and exciting when we fancy it and the opportunity arises. Or to not feel guilty about saying ‘no’ to something which we don’t, if we are honest with ourselves, really want to do. When I lie on my death bed/sofa/rug/lino, I might well regret dragging myself to ‘that work thing’ that I said yes to in a moment of weakness and it lasted for 5 painful and awkward hours, or Dave’s 52nd birthday do at the bowling alley which I didn’t want to go to but a combination of guilt and coercion meant that I did (sorry Dave). But more importantly, I might regret not reducing my hours or giving up work completely when I had the chance. I might regret not exploring the UK and Europe with my wife in a campervan. I might regret having never seen the pyramids. If these things are realistic and possible, finances permitting, in the near future, should I take steps to make them happen? I might regret not finding the time to try and learn how to play the drums. I could have made a start if I hadn’t gone to Dave’s party…
But despite all this talk about the heavy, important stuff, where are the moments for fun, laughter, and - you know - frivolity? Does the increased awareness of Old Father Time in my vicinity mean that everything has to be solemn and vital? My last blog post concluded with a thought about the small things which we take for granted but which constitute a large part of our waking lives. If we can’t enjoy the little moments, they might either slip away from us or just dissolve into meaninglessness.
I suppose that what I am ultimately trying to find is a balance. Being aware of the fragility of the future but not being paralysed by it. Being able to guiltlessly decline time-sapping burdens but find the space for spontaneity and random joy.
If anyone knows the answer, then feel free to get in touch. But do it sooner rather than later, please?
