Thinking in Cliches

[From Bellevue Literary Review Vol. 1 Issue 1. Fall 2001.]

The Diagnosis

You, a 67 year-old cardiologist with a PhD in music theory and an avid interest in ancient Greek history, find yourself re-examining old lessons.  The one thing our patients ask, you cannot answer, your first medical professor had warned you.  What will happen to me, is all patients care about, and precisely what you do not know.  Until then, you had believed in percentages, prognoses, and five-year survival rates.  You know what will happen to one thousand people, he had said, but you do not know about the one sitting before you.

They are thousands, millions even, when you read about them in medical journals:  133,500 new cases of colorectal cancer this year, 54,900 deaths.  But when you are the one sitting before your doctor, you find a new definition of the doctor-patient relationship within yourself.  You find yourself asking the same question: What will happen to me?  And you have the same desires to live and to escape suffering, as the countless others who have passed through this office before you, though you’d like to believe yourself unique.  And now that you sit, wrapped in your gown, shivering from what you hope the doctor thinks is the cold, but what is actually fear, your question does not seem ordinary.

The Aftermath of Remission

You begin to understand that the hard part of your illness is not dying, it’s living.  How much easier to endure pain, and to “have courage,” and maybe to “inspire courage,” or, even better, to “inspire admiration,” and finally to accept an end.  After all the pain and blood, you almost begin to think of death as the next therapy, because that’s what it is, you realize.  Death is part of the process.

But after much surgery and chemotherapy, you are surprised to find yourself still alive.  You have acquired a colostomy along with a new way of seeing the world, as clichéd as the phrase may sound.  But what is crushing you, is that this personal growth comes at the expense of separating you from those previously held close, those who have not just finished fighting for their lives, as you have.  You have won, thought it does not seem to be a joyous victory.  You have found that what you thought you wanted is not what you want now, and, unlike cancer, you cannot imagine a remedy for that.

For example, what is your wife supposed to say when you tell her that the reason you cannot stand to be with your best friend of twenty years – despite his intelligence, humor, and admiration for the members of the second Viennese school – is that he cannot use a knife and a fork.  He is, of course, fully capable of cutting his steak using both utensils and both hands, but he stabs his fork into the beef with his left hand, and then cuts through the meat with the knife in his right hand. You observe this and are embarrassed to be at the table with him.  While he chews the meat, ruminating on the potential hilarity of a plot twist where Webern, Schoenberg’s protegé, is called upon to beat up Schoenberg’s wife’s lover, you observe that he must rest the knife on the side of the plate and then switch the fork to his right hand before bringing the meat to his mouth.  How are you supposed to respond, when you, yourself, had found this same inadequacy of European table manners to be a cherished idiosyncrasy in your wife?

Is it that what you’re really saying to your wife has nothing to do with knives and forks? Is it that there is something in your friend that makes it impossible for you to sit across from him as though you’d never had colon cancer? And the best evidence you can garner to support this certain, but illogical, feeling, is your friend’s lack of table etiquette.  And all this time while you talked to your wife about knives and forks, you actually meant conversation, conviviality or lack thereof, and complete miscommunication.  And now that you think of it, you find your friend’s emotional responses to you and your illness obtuse.  He does not know what to say, or the right time to say it, and he does not understand you at all while he chatters on about Webern, and that is what leaves you contemplating the listlessness of the knife propped on his plate.

Because what if you don’t die? What if you have colon cancer and you suffer, and your children and grandchildren suffer, and your wife is loving and supportive though she, herself is mourning your illness? What if your friends send you flowers and musical cards with Schoenberg’s music filling your room, while the nurses wonder what the atonal noise is? What if you spend weeks in the hospital, time you believed was your last among people, time during which everyone told you they loved you and would miss you? And then it turns out, months later, you are still here among the living – to stay, it seems – and no one has much to say to you, nor you to them.  How much simpler it would have been to have died.

Life After Death

The ancient Greeks wrote their daily records on unfired clay that they could re-use, while etching their permanent accounts into wood.  A great fire swept the city and baked the clay, turning the mundane and transient into eternal, while the wood with its noteworthy chronicles fueled the fire.  You know now that the ordinary details of your days are what have made your life.  You do not await the appropriate moment to make a grand gesture with which to demonstrate your love for your wife and children.  You prove it to them each day in the tone of your voice and your attention to them.  You only hope that you will be lucky enough to have a fire sweep the city before your clay is recycled, and someone else’s ordinary life is recorded on what used to be your slate.

Because now that you are alive, you have a new set of questions.  You need to find something meaningful to do with your time.  Staying alive has occupied your mind exclusively, now that you are still here, you don’t know what to do with your life or why it matters anymore.

There are things you cannot do.  You have lost parts of yourself.  Actual physical body parts that you had utilized every day are no longer available to you, parts that helped you control your bowels.  But worse than having the colostomy is that the most productive, and therefore satisfactory, part of your day is managing your colostomy.  You don’t know what to do with your time, because that’s what it is now – time – not life as you used to think of it so grandly during your battle.  And you have come to understand a great lesson in writing: Clichés exist only in art.  Clichés do not exist in life.

Decades earlier, a college writing professor had warned you: In life, each kiss, each sexual act, is different.  To this list you add, each patient, each history, each physical exam.  And because you are experiencing a new art, you modify even further: Clichés are a failure of art.  This you interpret as: Banal patients are a failure of art also.  They are a failure of the art of medicine.  You find yourself thinking of the art of medicine as an art, with no need to put it in quotations.  You use the words sincerely in an attempt to describe what you see.

The Greeks were the first ones to say that human life is important and death is bad, you say to your class of medical students, as you introduce them to literature and medicine.  They chuckle.  No, really, you gaze at them over your glasses.  Others said that human life is meaningless – that the life of a person is worth the life of a cow.  You keep your eyes fixed on the class, your body shielded from their view, your hands gripped on the lectern.  They all wait in silence.  Or that there is no death; that life cycles and there is life after death, or reincarnation.  You are staring past the students, past the exit signs of the lecture hall, searching beyond the aged wooden doors.  Strands of your white hair fall over your eyebrows.  You brush them aside and focus on the class again.  The Greeks were the first ones to say that human life is important and death is bad, you tell them.

Blindness Cured

But the miraculous thing – and it is miraculous – is that you make a new life.  You take a new road of discovering what your story is about.  Those are the words you use to describe it now: your story.  You have learned lessons that you repeat to yourself in your mind.  You don’t say them aloud often because they sound like cliches, but you have lived them and understand them in a way that is not banal at all.  For example, you have discovered that the essence of you is not in your bowels.  People who have not lost a rectum will nod at this and reflect on the statement’s lack of ingenuity.  You do not know how to explain this discovery any more clearly to them, and they smile at you in sympathy, thankful that you have made them aware of their luck, particularly in terms of bowel control, and once again they will admire you for your courage.  You can talk about how life is better now that you’ve had cancer, and your friends will nod again, but only because they want you to feel this way.  They don’t actually believe it to be true.

You now have a new understanding of Sophocles and Oedipus that is profound, and it seems requisitely banal, because it is simply an observation that a high-school sophomore might make in her English class – that only after Oedipus lost his eyesight could he truly see.  And of course, our friends all agree that for Oedipus this seems to make sense. They have had the benefit of being the omniscient audience and knew the predictions from the start.  And they are still convinced that it was Oedipus who was blind, not they.  They do not understand that there is something to be seen through illness.  They agree with you, because maybe it was important for you to go through this to reach a new place.  But they cannot imagine that such a place exists, that such truths can only be found by nearly losing a life – and certainly losing a rectum – truths that cannot be recognized simply by sitting in a chair, external anal sphincter voluntarily closed, and thinking really hard.

Finally you adjust.  This does not happen suddenly, but sneaks up on you in the same way that you did not notice when the pain left, but only thought of it later when you realized you were no longer suffering.  You find yourself transformed, unable to explain this to those who have not journeyed themselves.  But you do not need to describe it to those who have.  You have found new friends who see the world as you do.  Growing pains, you think, and it’s odd that your thirteen year-old granddaughter who is changing interests, changing friends, and changing body can understand what you’re talking about, while your thirty-seven year-old daughter is simply glad that you are smiling again.

You’ve become a hedonist now.  You are greedy with life and want everything from it.  Gluttonous to take all that is offered and you still ask for more.  You read literature, which is profound because it makes you laugh.  You float about the symphony hall with Schoenberg, Mozart, and Verdi.  You watch actors on stage, heroic in their willingness to show you their life, ordinary as you may find it, their souls naked but for a playwright’s graceful words.  You hold your wife’s hand beside you, and you do not find golf nearly as boring, because her smile is your pleasure.

It’s important to become someone you like, you say and catch yourself in your lack of originality.  Your daughter is washing the dishes while your granddaughter peels the potatoes.  You continue, unafraid to be laughed at.  Speaking truthful, unoriginal aphorisms is a badge that survivors of terminal illness earn.  If you succeed at this one thing, you say to both of them over the running water, you will be grateful for every part of your life.  You start coughing and your granddaughter comes to the dining table where you sit and starts to slap your back.  The loud thumps of her hand against your skin give rhythm to your coughing.  Your daughter is now standing in front of you, her hand nudging a tissue toward your face.  You take it and with a final forceful blow you eject mucus worthy of elevating the exercise to productive.  It was a productive cough, your doctor would have noted in your chart.  You will be grateful for all of your life, you repeat, even the bad parts.

This is the wisest thing you have ever heard, but you wonder whether it will take decades for your children – even longer for their children – to understand what you mean.  The simplicity is startling.  If you like who you are now, then all of the experiences that have shaped you were a necessary part of the trip to get here.  You listen to your granddaughter tell you about polyphony in Bach’s cantatas and you hold back tears of joy.  Never before did you believe that eyes could water in happiness other than in hyperbolic descriptions by overwrought grandmothers.  And at that moment, with tears flowing down your cheeks and your granddaughter looking up at your face in amazement, you are grateful for all of your life, even the bad parts you can’t bring yourself to remember right then.

3 Responses to “Thinking in Cliches”
  1. Vera says:

    Another incredibly moving and well-written piece – the medical profession (not to mention the rest of us which will likely be patients in some way or another at some point) is lucky to have you.

    • omnimom says:

      i couldn’t agree more! a graceful and thought-provoking take on the doctor-turned-patient motif. and i can’t help but love the fact that this particular doctor’s interests are the ancient greeks and music theory, like two people you know rather well…

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