Originally posted February 3, 2009
The Rieff article kind of bothered me all day.
At one point, Sontag declared that she was not interested in enhancing the quality of her life, but rather any means necessary in saving, or at least prolonging it. Maybe I took more of the Richard Posner approach—fighting to the end for what I perceived as scraps of life seemed counter-intuitive to me. I’m not quite sure what I would’ve done if not only chemo ended up failing me, but also second- and third-line treatment as well: I would hope I’d be healthy enough to fly to Berlin and spend my last remaining days there.
Which inevitably leads to what I always had a morbid curiosity about: how exactly do you die of cancer? How does your body shut down? Are you lucid? Do you feel any conscious pain? Given the extreme optimism of my prognosis because I was young and had the “good kind of cancer,” none of the doctors found it necessary to tell me what were to happen if I were not to win. Even when my oncologist told me that a transplant was becoming more of a reality than a semi-distant abstraction, it never occurred to me that it could fail, or I could very plausibly die of a simple infection during the process. Reading a general biography for Sontag’s death yielded little: “Sontag died in New York City on 28 December 2004, aged 71, from complications of myelodysplastic syndrome which had evolved into acute myelogenous leukemia.” Rieff, however, chronicled his mother’s final days more generously, and in the end, God does reside in the details:
About 48 hours before the end, she began to fail, complaining of generalized low-grade pain (possibly indicating that the leukemia was in her bloodstream). Shortly after, she came down with an infection. Given the compromised state of her immune system, the doctors said, there was little chance that her body could stave it off. She remained intermittently lucid for about another day, though her throat was so abraded that she could barely speak audibly and she was confused. I feel she knew I was there, but I am not at all sure. She said she was dying. She asked if she was crazy.
By Monday afternoon, she had left us, though she was still alive. Pre-terminal, the doctors call it. It was not that she wasn’t there or was unconscious. But she had gone to a place deep within herself, to some last redoubt of her being, at least as I imagine it. What she took in I will never know, but she could no longer make much contact, if, indeed, she even wanted to. I and the others who were at her side left around 11 p.m. and went home to get a few hours’ sleep. At 3:30 a.m. on Tuesday, a nurse called. My mother was failing. When we arrived in her room, we found her hooked up to an oxygen machine. Her blood pressure had already dropped into a perilous zone and was dropping steadily, her pulse was weakening and the oxygen level in her blood was dropping.
For an hour and a half, my mother seemed to hold her own. Then she began the last step. At 6 a.m., I called Nimer, who came over immediately. He stayed with her throughout her death.
And her death was easy, as deaths go, in the sense that she was in little pain and little visible anguish. She simply went. First, she took a deep breath; there was a pause of 40 seconds, such an agonizing, open-ended time if you are watching a human being end; then another deep breath. This went on for no more than a few minutes. Then the pause became permanence, the person ceased to be and Nimer said, “She’s gone.”
There was unimaginable relief when I realized it could be a relatively merciful process—you certainly feel it, but perhaps with limited agony. In the six-plus months of treatment, I had the misfortune of being completely lucid for just about everything: from my bone marrow biopsy, to my needle biopsy, to my vocal injection, to the post-chemo hangovers, to all the infections my body was unable to fight off, to the allergic reactions from various drugs, to post-op healing, to enduring hundreds of shots. The idea of experiencing something exponentially more acute than any of that depressed more than terrified me because I had become exhausted of the pain. It gets familiar, but certainly never old. For a very long time, I saw death not as a cessation from the pain, but simply as one big culmination of it before the inevitable end.
There was, however, the one incident where I had the luxury of not being lucid , i.e. I had died without actually suffering through the process of dying. Almost ruefully, I admitted to friends that it felt like nothing because absolutely nothing happened, although doctors tell me that on the contrary, everything happened. There’s no real poetic way to describe it than one day I was alive, and then I wasn’t, and then I was again. And then I wasn’t. But then I was. In many respects, I considered it the easiest time I had, especially compared to the shit show my friends and family went through waiting to see if my lung would re-inflate and if the tumor would retard enough to get the fuck off my trachea. I came away from the experience with no profound spirituality or deeper understanding of anything. It simply happened, and I shrugged and moved on.
Which brings me back to Rieff’s article. There was a certain naivete in reading it because I believed that he would talk about his mother’s illness in more philosophical and poetic terms. Cancer is much easier to digest when viewed as an abstraction, or at least the literary equivalent to a baby seal. Instead, Rieff chose to focus on the appeals to her insurance company, the impossibility of drawing the line of what is medically futile, the unequal access to healthcare in the United States, and finally, in intimate detail, the course of her decline. In the end, perhaps it is that what bothered me about Rieff’s article: while Sontag’s obituaries were quick to celebrate her life as one of our most important essayists, Rieff made no concessions in documenting the process of her death.