As health care interpreters working in a great hospital such as that of the University of Michigan most of us have or have had at some point patients which were told, unfortunately, of an approaching close encounter with the grim reaper; each patient likely looking forward to it in a different way. Although this is a particular painful subject, one that most people consider somber and unpleasant, and would prefer to avoid talking about it, it is a meeting that eventually we will all have to acknowledge.
Diverse origins, cultural backgrounds, and personal beliefs will deeply affect a patient’s attitude to this encounter. Being aware that not everybody is facing it in the same manner, I would like to introduce you to two very courageous individuals: Christina Middlebrook, a Jungian analyst and psychotherapist, and Christopher Hitchens, an author and journalist, who being told by their doctors of this upcoming rendezvous decided to write about it from their points of view, relating their experience, their fears, and their hopes that this particular announcement was somehow due to a medical mistake. Their reflections have been expressed in length in the following two books:
• Cristina Middlebrook. 1996. Seeing the Crab: A memoir of dying. Basic Books, New York. xii, 212pp. Jonquils Award from the Duke University Comprehensive Cancer Center, honoring “efforts to increase awareness and give hope” to those with cancer. “Books for a Better Life” award for memoir, 1997.
• Christopher Hitchens. 2012. Mortality. Twelve, New York and Boston. xvi, 108pp.
As mere spectators to this encounter it might appear as shear rudeness, or at least extreme impoliteness, to favor the subject into a conversation. However, the patient’s point of view regarding that matter can be at the opposite side, expressing a willingness to discuss it as deeply as possible to help release the tension and anxiety that the mere thinking about it brings up.
As explained by Middlebrook, “I never dreamed the difficulty people have finding a way to speak about cancer, serious illness, death. Sometimes others’ need to minimize what has happened startles me. An old friend, a good friend, commented offhandedly that he would not attend a talk I gave at work about how I delegated my analytic practice when I took ill because, he said, ‘it’s too depressing’.” (…)I am astonished. Did I used to speak that way myself? Probably. (…)
It might be difficult for the outsiders (family members, friends, medical providers, interpreters) to actually figure out what the patient will need the most, and it might seem that that particular subject will be the last thing the patient would be willing to discuss. However, at least for some, Middlebrook among them, there is a tiny library of not-so-popular books, by a few intrepid souls who write about the journey, shaped by cancer and other diseases, from life through death.
Middlebrook also explains that since her diagnosis she perceives things differently than she used to: “My disease, no matter what someone else’s is, is the standard for which I make all my pronouncements.” And reclaims her rights to disagree with the politically correct behavior of medical providers, and to be infuriated by her own behavior and personal health condition: “Eventually I understood the gimmick. The word healing, as used by (…), does not refer to a cure, which is what I wanted, but to an attitude to accompany me so that I can smile my way through this vile disease. I think dying is difficult enough without having to achieve a pleasant attitude in the process.”
A medical condition that, as expected, is not affecting her alone, but is also affecting her closest relatives and friends, “Not driving, making me drive despite my chemotherapy, I realized, was her unwitting attempt to keep me alive.”
Hitchens, however, does not allow the crude reality of his cancer to interfere with his personality and he tries his best to be himself, keeping alive his sense of humor, which undeniably permeates the whole essay like when talking about tumortown, wellville, and tumorville.
In his writing there is a powerful combination both of seriousness, as he discusses how he is affected by his illness, and fanciness, keeping life alive and sparkling in spite of burdensome treatments, the undergoing changes of his body, and everything he has to put up with, both physically and physiologically, due to his malady: “( …) we [humans] are the only ones who can deploy vocal communication for sheer pleasure and recreation combining it with our two other boasts of reason and humor to produce higher synthesis. To lose this ability is to be deprived of an entire range of faculty: It is assuredly to die more than a little. (…) I feel upsettingly denatured. If Penélope Cruz were one of my nurses, I wouldn’t even notice. (…) I have slightly stopped issuing the announcement that ‘whatever does not kill me, makes me stronger’.”
And with all his seriousness, and particular personal position as a very sick cancer patient, he embraces the opportunity to bring into discussion ethical issues of prime importance in the current social sphere such as the patient’s rights upon his/her own life:
Sidney Hook, Stanford, CA (…) he wished he had been permitted to expire. He gave three reasons:
(1) Another agonizing stroke could hit him, forcing him to suffer it all over again.
(2) His family was being put through a hellish experience.
(3) Medical resources were being pointlessly expended.
Middlebrook and Hitchens’ approaches to the subject are undoubtedly very different, but both of them point out the apparent discrepancy, uneasiness, and difficulty of non-patients to address the subject among very ill patients, independently of the relationship they may have with them. Even though we all know that at some point we will be accompanying the grim reaper to the ballroom, the most likely uncertainty of the performance itself and the time and ultimate nature of its outcome, the way we might view it and approach it is, again, imbedded deeply in our cultural background and personal beliefs. It is for this that any discussion on this unwelcomed subject, true as it is that will not dissipate any uncertainties we might have I am sure it will expand, by providing us with visions that will likely be different from ours, the spectrum of our interpreting skills.
Other books on the subject (as mentioned by Middlebrook):
• Butler, Sandra; Rosenblum, Barbara. 1996. Cancer in two Voices. 2nd Ed., Spinsters Ink Books, 275pp.
• Wilber, Ken 2001. Grace and Grit: Spirituality and Healing in the Life and Death of Treya Killam Wilber. Shambhala; 2 edition. 504 pp.
• Nan Shin. 1988. Diary of a Zen Nun. Plum * Nanette Asimov, San Francisco Chronicle, January 26, 2009.