How Did You Deal With It? The existential crisis: How do we accept becoming mortal?

“How Did You Deal With It?” 

My daughter Dorothy asked me this. She wanted to know how I handled being told that I had cancer. 

It has been more than 5 years now and the further away from it I get, the less the likelihood of a recurrence. But we didn’t know that early on. In those first years after the diagnosis, the statistics said I had a 50% chance of recurrence and death. 

She asked me how I dealt with the “existential crisis.” 

How do you understand that you are mortal? How do you understand that life moves forward? We grow older and as much as we wish we can, we can’t go back. How do we live with that? What does that do to you? How do you live knowing that you are going to die someday?

In that moment, I tried to answer her, but I don’t think I did a very good job. It is a hard question to answer in a few words. It is complicated. Or at least it is complicated if I am to answer in a way that is complete, honest, and real. I hope now, with a few years to think and process, I can answer her question a bit better.

It helped that I have learned how to take gut punches:

I was 53 at the time of my diagnosis. It helped being 53. I would not have done as well if I were 23 or 33. I know that made it easier. It didn’t make it easy, but just easier. 

It helped me to have the knowledge and experience to have lived through dozens of “gut punches.” I hate these gut punches. But I have gotten used to them. 

What are gut punches? They are the sudden news of something terrible. 

In medicine we have gut punches. Our pager goes off and we answer the call and are told of some horrible catastrophe that has happened to our patient. We try to handle this as professionals. There are times that these calls have reduced me to tears.  I am not alone. Privately, I have seen very experienced physicians reduced to sobs by these gut punches. Usually, it is hidden away in a corner and then we pull ourselves together and go on with what we need to do.

I worry a lot after medical procedures. We learn to be meticulous and careful. We gain techniques to be safe and minimize complications. But with every procedure comes a risk of some adverse event. When the pager goes off, I tense up, prepare myself and then call. Usually, it is nothing and I can relax, but not always.

I remember stories about how Houdini would challenge people to punch him as hard as they could. He would tense his abdominal muscles so the punch wouldn’t cause him injury. Like Houdini I have learned to tense my abdomen and wait for the hardest punch people can throw at me. Usually everything is fine. At times it would be some horrible, unexpected change in a patient’s condition. Or maybe it is a tragedy of a friend or family member. The phone rings, my muscles tense and I prepare. This world can be miserable. I have, as I suspect you have also, lived through many gut punches. 

I wasn’t really surprised as much as I perhaps should have been. That night in the emergency room the PA had told us it was a kidney stone and that we would be on our way back home soon. When the ER doc came in, we could tell something else was going on. I had known him for many years. I could see it on his face. He had the unfortunate job of pointing out my tumor. We prepared for the gut punch. “Okay, tell us…” 

When you have lived long enough and gone through enough gut punches you know that you can handle them and still go on. The 1^st drop on a roller coaster is intense. Each hill, each up and down and curve after that you can enjoy more having gone through the first drop. It helped being 53. 

I learned that the “bucket list” is not something that I needed.

The morning after the diagnosis came the need for information. People had said to not look things up. I was not supposed to be my own doctor. But what would you expect me to do? I had to. There had to be a differential diagnosis for softball sized retroperitoneal tumors. Like the clinician that I am, I drew up a list of differential diagnoses.  Associated with each potential diagnosis was a prognosis, including a treatment, a recurrence rate, and a 5-year survival rate. 

Or to put that another way – a 5-year not-survival rate. 

Everyone is different in how they cope. I had to know. I had to think and plan and figure it out. That’s what I do. I find problems and look objectively at solutions. It was my way to cope.

With that information I started asking hard questions. 

I was suddenly finite – at least in terms of my years on this earth. I was mortal. When I was young the world was wide open with possibilities and things that I was going to do “someday.” Most of them I was not going to ever do but the idea of doing them was nice. But in that moment after being given a scary diagnosis, I realized the prospects were all narrowing down. 

It was always assumed that someday I would retire. I pictured the old guy in mismatched clothes, wearing black dress socks and shorts going for a morning walk by the condo complex in Florida. Now – maybe not. Maybe I was going to be the guy with the beach house on St George Island who walked the beach every morning and again every evening. But now, maybe not.

What should we do? Should we make changes in our lives?

Sarah indulged me. Or perhaps better – we indulged ourselves and started feeling ideas out. We drove to Holland, and we started driving around neighborhoods. We were looking at houses for sale on the water. We walked around and imagined what it would be like to live at one of them. The idea of living on the water is always appealing. Getting up each morning and seeing and hearing the water is a dream I think a lot of people have. Why not? Maybe we should sell our house and buy the place on the water. If I wasn’t going to be able to do it at 65 years of age, should we do it now?

It helped. It was therapeutic to look and think and dream. The more we did so, the less important it became. It was the idea itself – the option – the choice – that was important to us. After a day of looking, I felt better. It was possible I wasn’t going to be able to do all the “maybes” and “somedays.” But the now was pretty good itself. 

This was important. It was about coming to terms with a finite life and being okay with not getting to do “everything”. No one really does everything they ever dreamed of. Some talk about a bucket list. Oddly, the more I thought about it the less important the bucket list idea became to me. It is the ability to choose that is important. Having thought about a lot of things, the things became less and less important. I have a lot of things. I have done a lot of things. I don’t have a bucket list. It really doesn’t appeal to me. I would much rather have a “how to maximally enjoy what I have right now” list. 

Grief:

Anger. That one surprised me. How dare it! Or more likely – how dare the world. Or maybe even how dare I. It was an unspoken assumption. There was a deal that I had with the universe. I would work hard. I would push myself. If needs arose, I would push myself harder and harder. Sometimes I would get up feeling so tired that I wondered how hard I could push, and then I would push some more. In return someday I would get a chance to rest. I would retire and I would be like “normal people.” I wouldn’t feel so tired. I would have time to sleep in. I would have time to play. I could relax. I wouldn’t be pushing so hard. I could stop pushing caffeine and myself to deliver on whatever I felt was so desperate for me to do.

How dare the world do this! “You have got to be kidding me. We had a deal. The deal was that I would sacrifice today and then I would get to enjoy it all tomorrow.” 

But now the world was laughing at me. “Surprise! You thought we had a deal. The thing is, you never really asked me. I am going to renege on the deal you thought we had. I never agreed to it. You just assumed it. It isn’t my fault. You were the one who was a fool. You assumed. Surprise! Not my fault. It isn’t shame on me. It is shame on you.”

I was going through the stages of grief. The stages have been described as: Shock / Anger / Bargaining / Depression / Acceptance.^[1]  I had been through shock. Anger came as the next stage. My anger was at the world and at myself for living a life that always felt too busy. 

Really? Now what? What was being taken away from me?

Back to the bucket list. This was oddly disturbing to me. Certainly, I had a bucket list. Because the “fairness” of the universe would insist that I couldn’t die until I had completed my bucket list. But I didn’t have one. This scared me. I had always wanted to own a sailboat. But we had bought one a couple of years ago. I wanted to sail it out and across Lake Michigan. We had done that. I had wanted to see my girls grow up. They were all out of the home now. Of course, I wanted to walk them down the aisle, see my grandchildren, and be there for them. But I worried that was assumed and wasn’t “big enough” to delay death. 

I worried that I didn’t have anything so important that the cancer had to stay away.  I had moved on to the next stage. I was bargaining.  But the world doesn’t really work that way. Whether or not I have a big bucket list does not control whether my cancer recurs or when it recurs or how long I live.

Depression? I supposed I have gone through waves of that. It helps having always been an optimist. I am not immune to it, however. In the times of limiting symptoms of my adrenal insufficiency it was hard to remain positive.

Acceptance. This is where you end up. Not all the time. The cycles start up again without warning. But the more you go through them the more time you spend in acceptance.

And in those moments of acceptance, when I am calm and rational, I realize that I have not been robbed. I have had a good life and have a good life now (see above).  I find it fascinating how mid career doctors can dream of retirement, but how older doctors often don’t want to retire. The future is important, but today is important too.

Floating (at times):

Faith. I have been very blessed. My Lord called me to a real and meaningful faith in Him in my teens. I told myself early on that if it wasn’t real I didn’t want it. I was going to insist on being honest with myself. I was going to believe not because I wanted to, but because it was what was true. That hasn’t always been easy. I have had to walk through times of questioning and doubt. But because of that, it has been a real faith. It is an honest faith. I am not worried about what happens to me after death. I know whom I have believed and am assured that He is able to keep that which I have committed to Him…^[2]” I am not afraid to die. 

Kate Bowler describes times of “floating.”^[3]

I want to be very clear. I am not a “super saint.” I am not this great man of faith who can set himself up for everyone to admire. When I get busy I struggle to keep up with daily devotions. My prayer life waxes and wanes. There are times when I have been so close to God. But the majority of the time I feel an underlying guilt about how I let the world, my life and the “busy-ness” of everything crowd Him out. 

But in the midst of the worst of it, He is there. The wonder of God is that He is faithful whether I am faithful or not. I cannot explain it, but I do know what the concept of “floating” means. I lack the faith to be brave. I am not really strong enough or good enough to be able to march in front of you and confidently tell you that, “By my faith I am not afraid.” But by God who has consistently been faithful to me I can tell you that He makes me not afraid. There are times when it really doesn’t make any sense to me. Those are the times that by the amazing grace and love of God I am floating. In those moments, even if it doesn’t make any sense, I am at peace.

It is not enough just to be alive. I needed to live:

I had learned that I could no longer just assume that the universe had a deal with me anymore. I could no longer defer and expect to get what was important to me. I couldn’t wait for everyone else to walk through the buffet line and assume that there would be plenty left for me. If everyone else ate until they were stuffed, and I starved because I held back – maybe not shame on them – maybe – it is shame on me. Maybe I have been the fool. Maybe I need to insist on living life – not rudely pushing in front of people – but maybe – not putting off living until tomorrow. Maybe I should insist on getting in the middle of the buffet line with everyone else. Maybe I should insist that we all share evenly. 

Many physicians – in fact – many professionals – make this error. They assume that tomorrow is when they will have the time that they long for to be with their families, to sleep, to breathe, to think and to feel. I wanted to scream at them. It is all a big ruse! Don’t be a fool! Do it now!

The feelings became strong. I drank them up like a wonderful and flavorful elixir. I longed to go beyond the things that had held me back before. I wanted to live. I wanted to love and be loved. I wanted whatever I was pretending the future would bring and I wanted it now. More than that, I wanted what today had in store for me and I wanted to experience it all fully and completely.

I worry sometimes that my blog posts just repeat the same concepts over and over again. Maybe they do. Maybe it is because I continue to try to learn and teach myself this lesson: It is how to enjoy the moments of today rather than wishing them away on tomorrow. Today has a LOT of really good stuff in it. Be careful to not miss it. Someday you are going to wish that you could go back to this very moment. It will look so appealing in the rear-view mirror. Could you be so wise as to enjoy it – I mean – really live it and enjoy it – now?

Rather than seeking something else in the future – could you potentially enjoy what is in the present? 

What would you say to someone who has a flavorful juicy steak in front of him but moans about not having a pizza? And then he has a piece of his favorite sizzling hot and just perfectly spicy pizza and all he says is that he wants a burger. He is a fool who fails to enjoy the good gifts of today and only dreams of tomorrow. He is a fool who lives for a bucket list and fails to enjoy the amazing full bucket of things that are sitting in front of him for him to enjoy today.

Just keep swimming…

When all is well and done that is all that any of us can do. You get up and you do your level best to enjoy the life you have been given and live another day. The next day you do the same thing and that is how you go on with life.

And so dear Dorothy, how did I deal with it? It is a long and complicated answer. By the grace of God, the love of my family and friends, and the wonderful life I have been given, I just did (deal with it). And the next day I did again. It may not be perfect, but I have been blessed with a lot.  And in spite of troubles, in spite of gut punches, and in spite of unfilled bucket list items what I do have is good.  

It is really good.

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^[1] https://en.wikipedia.org/wiki/Kübler-Ross_model

^[2] 2 Tim 1:2, New International Version

^[3] Kate Bowler, “Everything Happens for a Reason And Other Lies I’ve Loved.”