Christopher Hitchens - Mortality

It’s normally agreed that the question “How are you?” doesn’t put you on your oath to give a full or honest answer. So when asked these days, I tend to say something cryptic like, “A bit early to say.” (If it’s the wonderful staff at my oncology clinic who inquire, I sometimes go so far as to respond, “I seem to have cancer today.”) Nobody wants to be told about the countless minor horrors and humiliations that become facts of “life” when your body turns from being a friend to being a foe: the boring switch from chronic constipation to its sudden dramatic opposite; the equally nasty double cross of feeling acute hunger while fearing even the scent of food; the absolute misery of gut-wringing nausea on an utterly empty stomach; or the pathetic discovery that hair loss extends to the disappearance of the follicles in your nostrils, and thus to the childish and irritating phenomenon of a permanently runny nose. Sorry, but you did ask… It’s no fun to appreciate to the full the truth of the materialist proposition that I don’t have a body, I am a body.

But it’s not really possible to adopt a stance of “Don’t ask, don’t tell,” either. Like its original, this is a prescription for hypocrisy and double standards. Friends and relatives, obviously, don’t really have the option of not making kind inquiries. One way of trying to put them at their ease is to be as candid as possible and not to adopt any sort of euphemism or denial. The swiftest way of doing this is to note that the thing about Stage Four is that there is no such thing as Stage Five. Quite rightly, some take me up on it. I recently had to accept that I wasn’t going to be able to attend my niece’s wedding, in my old hometown and former university in Oxford. This depressed me for more than one reason, and an especially close friend inquired, “Is it that you’re afraid you’ll never see England again?” As it happens he was exactly right to ask, and it had been precisely that which had been bothering me, but I was unreasonably shocked by his bluntness. I’ll do the facing of hard facts, thanks. Don’t you be doing it too. And yet I had absolutely invited the question. Telling someone else, with deliberate realism, that once I’d had a few more scans and treatments I might be told by the doctors that things from now on could be mainly a matter of “management,” I again had the wind knocked out of me when she said, “Yes, I suppose a time comes when you have to consider letting go.” How true, and how crisp a summary of what I had just said myself. But again there was the unreasonable urge to have a kind of monopoly on, or a sort of veto over, what was actually sayable. Cancer victimhood contains a permanent temptation to be self-centered and even solipsistic.

So my proposed etiquette handbook would impose duties on me as well as upon those who say too much, or too little, in an attempt to cover the inevitable awkwardness in diplomatic relations between Tumortown and its neighbors. If you want an instance of exactly how not to be an envoy from the former, I would offer you both the book and the video of The Last Lecture . It would be in bad taste to say that this—a pre-recorded farewell by the late professor Randy Pausch—had “gone viral” on the Internet, but so it has. It should bear its own health warning: so sugary that you may need an insulin shot to withstand it. Pausch used to work for Disney and it shows. He includes a whole section in defense of cliché, not omitting, “Other than that, Mrs. Lincoln, how was the play?” The words “kid” or “childhood” and “dream” are employed as if for the very first time. (“Anyone who uses ‘childhood’ and ‘dream’ in the same sentence usually gets my attention.”) Pausch taught at Carnegie Mellon, but it’s the Dale Carnegie note that he likes to strike. (“Brick walls are there for a reason… to give us a chance to show how badly we want something.”) Of course, you don’t have to read Pausch’s book, but many students and colleagues did have to attend the lecture, at which Pausch did push-ups, showed home videos, mugged for the camera, and generally joshed his head off. It ought to be an offense to be excruciating and unfunny in circumstances where your audience is almost morally obliged to enthuse. This was as much an intrusion, in its way, as that of the relentless motherly persecutor with whom I began. As the populations of Tumortown and Wellville continue to swell and to “interact,” there’s a growing need for ground rules that prevent us from inflicting ourselves upon one another.

LIKE SO MANY OF LIFE’S VARIETIES OF EXPERIENCE, the novelty of a diagnosis of malignant cancer has a tendency to wear off. The thing begins to pall, even to become banal. One can become quite used to the specter of the eternal Footman, like some lethal old bore lurking in the hallway at the end of the evening, hoping for the chance to have a word. And I don’t so much object to his holding my coat in that marked manner, as if mutely reminding me that it’s time to be on my way. No, it’s the snickering that gets me down.

On a much too regular basis, the disease serves me up with a teasing special of the day, or a flavor of the month. It might be random sores and ulcers, on the tongue or in the mouth. Or why not a touch of peripheral neuropathy, involving numb and chilly feet? Daily existence becomes a babyish thing, measured out not in Prufrock’s coffee spoons but in tiny doses of nourishment, accompanied by heartening noises from onlookers, or solemn discussions of the operations of the digestive system, conducted with motherly strangers. On the less good days, I feel like that wooden-legged piglet belonging to a sadistically sentimental family that could bear to eat him only a chunk at a time. Except that cancer isn’t so… considerate.

Most despond-inducing and alarming of all, so far, was the moment when my voice suddenly rose to a childish (or perhaps piglet-like) piping squeak. It then began to register all over the place, from a gruff and husky whisper to a papery, plaintive bleat. And at times it threatened, and now threatens daily, to disappear altogether. I had just returned from giving a couple of speeches in California, where with the help of morphine and adrenaline I could still successfully “project” my utterances, when I made an attempt to hail a taxi outside my home—and nothing happened. I stood, frozen, like a silly cat that had abruptly lost its meow. I used to be able to stop a New York cab at thirty paces. I could also, without the help of a microphone, reach the back row and gallery of a crowded debating hall. And it may be nothing to boast about, but people tell me that if their radio or television was on, even in the next room, they could always pick out my tones and know that I was “on” too.

Like health itself, the loss of such a thing can’t be imagined until it occurs. In common with everybody else, I have played versions of the youthful “Which would you rather?” game, in which most usually it’s debated whether blindness or deafness would be the most oppressive. But I don’t ever recall speculating much about being struck dumb. (In the American vernacular, to say “I’d really hate to be dumb” might in any case draw another snicker.) Deprivation of the ability to speak is more like an attack of impotence, or the amputation of part of the personality. To a great degree, in public and private, I “was” my voice. All the rituals and etiquette of conversation, from clearing the throat in preparation for the telling of an extremely long and taxing joke to (in younger days) trying to make my proposals more persuasive as I sank the tone by a strategic octave of shame, were innate and essential to me. I have never been able to sing, but I could once recite poetry and quote prose and was sometimes even asked to do so. 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.” At least they don’t have to pay attention for long: I can’t keep it up and anyway can’t stand to.