On the Op-Ed page of The New York Times last week, renowned neurologist Oliver Sacks announced his impending death from terminal cancer.
True to his nature – or what I know of it from his 12 books and dozens of stories and reports in The New York Review of Books – his essay is eloquent, thoughtful, honest, beautiful, inspiring and for us who will be left behind, deeply sad.
”The cancer occupies a third of my liver,” he explains, “and though its advance may be slowed, this particular sort of cancer cannot be halted.
“It is up to me now to choose how to live out the months that remain to me. I have to live in the richest, deepest, most productive way I can.”
Of course he does. The man I have come to respect and admire and learn from over decades of reading could do no less.
Given what I know of TimeGoesBy readers – well, those of you who comment regularly – I suspect that a large number of you have already read this piece and it is so complete in itself, there is nothing worthy I can add.
But at a blog dedicated to what it is really like to get old, neither can I let this go unmentioned, so a few words of personal response.
In one section, Dr. Sacks reminds me of what I hope for about my own demise in a description that is amazingly close to what I experienced some years ago when an accident convinced me that my death was imminent:
”Over the last few days,” writes Sacks, “I have been able to see my life as from a great altitude, as a sort of landscape, and with a deepening sense of the connection of all its parts. This does not mean I am finished with life.
“On the contrary, I feel intensely alive, and I want and hope in the time that remains to deepen my friendships, to say farewell to those I love, to write more, to travel if I have the strength, to achieve new levels of understanding and insight.”
Although it involves a death sentence delivered, I assume, with an approximate time table, I passionately wish to be granted that time.
My mother was. For the same diagnosis as the good doctor, she was given three or four months during which I cared for her, and what Sacks expects to do with his remaining time is similar to what I watched in my mother:
“I feel a sudden clear focus and perspective. There is no time for anything inessential. I must focus on myself, my work and my friends. I shall no longer look at NewsHour every night. I shall no longer pay any attention to politics or arguments about global warming.
“This is not indifference but detachment — I still care deeply about the Middle East, about global warming, about growing inequality, but these are no longer my business; they belong to the future.”
Exactly - “detached.” I felt that in my own accident and watched it happen both with my mother and with other loved ones as they were dying. In this remarkably brief essay, Dr. Sacks covers a lot of important ground; he is still, as he has all these years, teaching us.
In May this year, his autobiography, titled On the Move, will be published. Here is the dust jacket which is remarked upon thusly at oliversacks.com blog where there is a larger image: “Yes, this is how Oliver Sacks rolled in 1961 (in Greenwich Village on his BMW).”
It pleases me to know this little thing about his younger self.
If you haven't read the essay, please do – it is a keeper to be read and re-read and read again. I also recommend a previous Op-Ed from Sacks in 2013, titled The Joy of Old Age (No Kidding.) It is equally important and Sacks is always a joy to read.
At The Elder Storytelling Place today, Dan Gogerty: Orthorexia, Healthy Food and “Piecing Around"
It is never easy to contemplate the end-of-life, whether its own our experience or that of a loved one.
This has made a recent swath of beautiful essays a surprise. In different publications over the past few weeks, I've stumbled upon writers who were contemplating final days. These are, no doubt, hard stories to read. I had to take breaks as I read about Paul Kalanithi's experience facing metastatic lung cancer while parenting a toddler, and was devastated as I followed Liz Lopatto's contemplations on how to give her ailing cat the best death possible. But I also learned so much from reading these essays, too, about what it means to have a good death versus a difficult endfrom those forced to grapple with the issue. These are four stories that have stood out to me recently, alongside one essay from a few years ago that sticks with me today.
My Own Life | Oliver Sacks
As recently as last month, popular author and neurologist Oliver Sacks was in great health, even swimming a mile every day. Then, everything changed: the 81-year-old was diagnosed with terminal liver cancer. In a beautiful op-ed, published in late February in the New York Times, he describes his state of mind and how he'll face his final moments. What I liked about this essay is how Sacks describes how his world view shifts as he sees his time on earth getting shorter, and how he thinks about the value of his time.
Before I go | Paul Kalanithi
Kalanthi began noticing symptoms — "weight loss, fevers, night sweats, unremitting back pain, cough" — during his sixth year of residency as a neurologist at Stanford. A CT scan revealed metastatic lung cancer. Kalanthi writes about his daughter, Cady and how he "probably won't live long enough for her to have a memory of me." Much of his essay focuses on an interesting discussion of time, how it's become a double-edged sword. Each day, he sees his daughter grow older, a joy. But every day is also one that brings him closer to his likely death from cancer.
As I lay dying | Laurie Becklund
Becklund's essay was published posthumonously after her death on February 8 of this year. One of the unique issues she grapples with is how to discuss her terminal diagnosis with others and the challenge of not becoming defined by a disease. "Who would ever sign another book contract with a dying woman?" she writes. "Or remember Laurie Becklund, valedictorian, Fulbright scholar, former Times staff writer who exposed the Salvadoran death squads and helped The Times win a Pulitzer Prize for coverage of the 1992 L.A. riots? More important, and more honest, who would ever again look at me just as Laurie?"
Everything I know about a good death I learned from my cat | Liz Lopatto
Dorothy Parker was Lopatto's cat, a stray adopted from a local vet. And Dorothy Parker, known mostly as Dottie, died peacefullywhen she passed away earlier this month. Lopatto's essay is, in part, about what she learned about end-of-life care for humans from her cat. But perhaps more than that, it's also about the limitations of how much her experience caring for a pet can transfer to caring for another person.
Yes, Lopatto's essay is about a cat rather than a human being. No, it does not make it any easier to read. She describes in searing detail about the experience of caring for another being at the end of life. "Dottie used to weigh almost 20 pounds; she now weighs six," Lopatto writes. "My vet is right about Dottie being close to death, that it’s probably a matter of weeks rather than months."
Letting Go | Atul Gawande
"Letting Go" is a beautiful, difficult true story of death. You know from the very first sentence — "Sara Thomas Monopoli was pregnant with her first child when her doctors learned that she was going to die" — that it is going to be tragic. This story has long been one of my favorite pieces of health care journalism because it grapples so starkly with the difficult realities of end-of-life care.
In the story, Monopoli is diagnosed with stage four lung cancer, a surprise for a non-smoking young woman. It's a devastating death sentence: doctors know that lung cancer that advanced is terminal. Gawande knew this too — Monpoli was his patient. But actually discussing this fact with a young patient with a newborn baby seemed impossible.
"Having any sort of discussion where you begin to say, 'look you probably only have a few months to live. How do we make the best of that time without giving up on the options that you have?' That was a conversation I wasn't ready to have," Gawande recounts of the case in a new Frontline documentary.
What's tragic about Monopoli's case was, of course, her death at an early age, in her 30s. But the tragedy that Gawande hones in on — the type of tragedy we talk about much less — is how terribly Monopoli's last days played out.