Christopher Hitchens - Mortality

I lay at the point of death. A congestive heart failure was treated for diagnostic purposes by an angiogram that triggered a stroke. Violent and painful hiccups, uninterrupted for several days and nights, prevented the ingestion of food. My left side and one of my vocal cords became paralyzed. Some form of pleurisy set in, and I felt I was drowning in a sea of slime. In one of my lucid intervals during those days of agony, I asked my physician to discontinue all life-supporting services or show me how to do it.

The physician denied this plea, rather loftily assuring Hook that “someday I would appreciate the unwisdom of my request.” But the stoic philosopher, from the vantage point of continued life, still insisted that he wished he had been permitted to expire. He gave three reasons. Another agonizing stroke could hit him, forcing him to suffer it all over again. His family was being put through a hellish experience. Medical resources were being pointlessly expended. In the course of his essay, he used a potent phrase to describe the position of others who suffer like this, referring to them as lying on “mattress graves.”

If being restored to life doesn’t count as something that doesn’t kill you, then what does? And yet there seems no meaningful sense in which it made Sidney Hook “stronger.” Indeed, if anything, it seems to have concentrated his attention on the way in which each debilitation builds on its predecessor and becomes one cumulative misery with only one possible outcome. After all, if it were otherwise, then each attack, each stroke, each vile hiccup, each slime assault, would collectively build one up and strengthen resistance. And this is plainly absurd. So we are left with something quite unusual in the annals of unsentimental approaches to extinction: not the wish to die with dignity but the desire to have died .

Professor Hook eventually left us in 1989, and I am a generation younger than him. I haven’t sailed as close to the bitter end as he had to do. Nor have I yet had to think of having such an arduous conversation with a physician. But I do remember lying there and looking down at my naked torso, which was covered almost from throat to navel by a vivid red radiation rash. This was the product of a monthlong bombardment with protons which had burned away all of the cancer in my clavicular and paratracheal nodes, as well as the original tumor in the esophagus. This put me in a rare class of patients who could claim to have received the highly advanced expertise uniquely available at the stellar zip code of MD Anderson Cancer Center in Houston. To say the rash hurt would be pointless. The struggle is to convey the way that it hurt on the inside . I lay for days on end, trying in vain to postpone the moment when I would have to swallow. Every time I did swallow, a hellish tide of pain would flow up my throat, culminating in what felt like a mule kick in the small of my back. I wondered if things looked as red and inflamed within as they did without. And then I had an unprompted rogue thought: If I had been told about all this in advance, would I have opted for the treatment? There were several moments as I bucked and writhed and gasped and cursed when I seriously doubted it.

It’s probably a merciful thing that pain is impossible to describe from memory. It’s also impossible to warn against. If my proton doctors had tried to tell me up front, they might perhaps have spoken of “grave discomfort” or perhaps of a burning sensation. I only know that nothing at all could have readied or steadied me for this thing that seemed to scorn painkillers and to attack me in my core. I now seem to have run out of radiation options in those spots (thirty-five straight days being considered as much as anyone can take), and while this isn’t in any way good news, it spares me from having to wonder if I could willingly endure the same course of treatment again.

But mercifully, too, I now can’t summon the memory of how I felt during those lacerating days and nights. And I’ve since had some intervals of relative robustness. So as a rational actor, taking the radiation together with the reaction and the recovery, I have to agree that if I had declined the first stage, thus avoiding the second and the third, I would already be dead. And this has no appeal.

However, there is no escaping the fact that I am otherwise enormously weaker than I was then. How long ago it seems that I presented the proton team with champagne and then hopped almost nimbly into a taxi. During my next hospital stay, in Washington, D.C., the institution gifted me with a vicious staph pneumonia (and sent me home twice with it) that almost snuffed me out. The annihilating fatigue that came over me in consequence also contained the deadly threat of surrender to the inescapable: I would often find fatalism and resignation washing drearily over me as I failed to battle my general inanition. Only two things rescued me from betraying myself and letting go: a wife who would not hear of me talking in this boring and useless way, and various friends who also spoke freely. Oh, and the regular painkiller. How happily I measured off my day as I saw the injection being readied. It counted as a real event. With some analgesics, if you are lucky, you can actually feel the hit as it goes in: a sort of warming tingle with an idiotic bliss to it. To have come to this—like the sad goons who raid pharmacies for OxyContin. But it was an alleviation of boredom, and a guilty pleasure (not many of those in Tumortown), and not least a relief from pain.

In my English family, the role of national poet was taken not by Philip Larkin but by John Betjeman, bard of suburbia and the middle class and a much more mordant presence than the rather teddy-bearish figure he sometimes presented to the world. His poem “Five O’Clock Shadow” shows him at his least furry:

I have come to know that feeling all right: the sensation and conviction that the pain will never go away and that the wait for the next fix is unjustly long. Then a sudden fit of breathlessness, followed by some pointless coughing and then—if it’s a lousy day—by more expectoration than I can handle. Pints of old saliva, occasionally mucus, and what the hell do I need heartburn for at this exact moment? It’s not as if I have eaten anything: a tube delivers all my nourishment. All of this, and the childish resentment that goes with it, constitutes a weakening. So does the amazing weight loss that the tube seems unable to combat. I have now lost almost a third of my body mass since the cancer was diagnosed: It may not kill me, but the atrophy of muscle makes it harder to take even the simple exercises without which I’ll become more enfeebled still.

I am typing this having just had an injection to try to reduce the pain in my arms, hands, and fingers. The chief side effect of this pain is numbness in the extremities, filling me with the not irrational fear that I shall lose the ability to write. Without that ability, I feel sure in advance, my “will to live” would be hugely attenuated. I often grandly say that writing is not just my living and my livelihood but my very life, and it’s true. Almost like the threatened loss of my voice, which is currently being alleviated by some temporary injections into my vocal folds, I feel my personality and identity dissolving as I contemplate dead hands and the loss of the transmission belts that connect me to writing and thinking.