Susan Sontag's final wish

Feb. 13, 2008 | David Rieff has written a sobering and often horrifying account of his mother's final days. In 2004, his mother, Susan Sontag, died from a brutal form of blood cancer, myelodysplastic syndrome. She fought her illness to the end, implicitly asking those closest to her, including her son, to lie: She didn't want anyone to tell her she was dying. It's a striking contrast. The celebrated writer demanded honesty of intellectuals -- Rieff says she loved reason and science "with a fierce, unwavering tenacity bordering on religiosity" -- yet maintained a willful delusion about her death.

In "Swimming in a Sea of Death," Rieff wrestles with how to be a dutiful son to his dying mother while being true to himself. It's a remarkably unsentimental account. There's no gushing between mother and son or deathbed reconciliations. This is not a portrait of Rieff's relationship with Sontag, though at one point he refers to their "strained and at times very difficult" relations. It is a book about dying, grieving and what it means to survive the death of a loved one.

Beginning in the 1960s, Sontag became a cultural critic with enormous range, dissecting everything from camp to Marxist critic Walter Benjamin, from photography to how illness is misread as a metaphor for patients' psychology. She was a best-selling novelist and a singular presence -- the brainy, glamorous woman who held her own among the testosterone-filled intellectuals of the period.

Rieff is a distinguished author in his own right. A contributing writer to the New York Times Magazine, and a past contributor to Salon, he's reported on war-ravaged countries and carved out his own reputation as an acute analyst of foreign policy. Rieff refers to writing as "the family olive oil business." His father, the sociologist Philip Rieff, wrote his own masterpiece, "The Triumph of the Therapeutic: Uses of Faith After Freud." Sontag married Rieff when she was 17 and left him seven years later. In her later years, she had a relationship with Annie Leibovitz, whom Rieff avoids discussing in his memoir, except for one loaded comment about the photographer's "carnival images of celebrity death."

"I am not a confessional person," Rieff insisted. He could be terse when fielding questions about his relationship with his mother, and he became angry at the notion she suffered a "bad death." Still, throughout our interview, he displayed his own brand of remarkable candor.

When did you first hear your mother had this form of blood cancer?

It was in the spring of 2004. I was coming back from about a month in Israel/Palestine, where I was trying to do a story on Yasser Arafat. I have a habit -- a superstition, really -- of not calling people I'm close to while I'm on an assignment that could be dangerous. But I usually check in once I get out. I had to change planes at Heathrow Airport in London, so I called my mother. She said she might be ill again, might have some kind of blood cancer. She was trying to be cheerful. I was trying to be cheerful. Then I flew back. The next morning, I picked her up and accompanied her to the doctor who gave her the test results. The physician was not a very empathetic guy. I'm sure he's a good doctor, but his human skills were not exactly brilliant. And he told her the bad news. She had this lethal blood cancer and, basically, there was no treatment.

It was a death sentence.

It was. The standard time between diagnosis and death is nine months, and there are no drugs that work more than a few months to keep your blood counts where they're supposed to be. It turned out that if she wanted to try something rather than palliative care during the last months of her life, there was one possibility. It's a long shot: an adult stem-cell transplant, a bone-marrow transplant. She found a physician at the great cancer center in New York, Memorial Sloan-Kettering, a brilliant man who had all the human skills the first doctor did not. He said, "If you want to fight, if what matters to you is not quality of life…" And my mother said, "I'm not interested in quality of life." He said, "Well, the best place to have this transplant would be at the Fred Hutchinson Center at the University of Washington Hospital in Seattle."

So she was going to do everything she could to survive.

She wanted to live at any price. When she said, "I'm not interested in quality of life," she meant it. She was somebody for whom extinction -- death -- was unbearable. So she was going to fight for every breath, no matter how much suffering that entailed.

Twice before, your mother had cancer and survived. One time, weren't the odds incredibly stacked against her?

They were. This was in the mid-'70s, a time when American physicians tended to lie to their patients and tell family members something closer to the truth. I was told by her doctors that she would die quite soon. She had Stage 4 breast cancer that had spread into her lymph system. She had a basis for thinking it wasn't hopeless when a doctor said it was.

Yet this time it did seem hopeless.

The chances were indeed stacked against her. But she didn't want to hear it. So what do you do, as the person who's close to someone who wants to live at any price, when you think this fight isn't worth it? Do you lie? Do you insist on telling the truth when it's perfectly clear the person doesn't want to know the truth? Which was certainly true of my mother.

Even though she did say, "Don't lie to me."

She wanted to be lied to. I mean, she didn't want to be lied to, but she wanted to live. She hoped that I and other people in her life would give her reason to hope. I felt that I had to do that, whatever my own opinion was. Before the transplant, I thought the odds were bad. Coming back to my mother's previous experience with breast cancer, I thought, "Well, don't leap to conclusions here. They wrote her off in the '70s. Yeah, it's an even more lethal cancer, and yeah, she's even 30 years older, but maybe she'll beat the odds." But when the bone marrow transplant started to go wrong soon after it took place, I didn't think she would make it. Yet every signal she was giving me was, "Give me hope. Help me believe I might make it." In the end, I chose to do that. The most important thing I thought was: It's her death, not mine.

Can you tell me about your mother's last days?

Everything that could go wrong did go wrong after the transplant. She suffered like someone being tortured. I found a way to be present but not look at the way she had become physically. She flew back to New York when it was clear the leukemia had become full-blown and the transplant had failed, and spent the last six or seven weeks of her life in Memorial Sloan-Kettering. In the end she couldn't even roll over unassisted.

Once she died, I asked the other people in the room to leave. And I really looked. To be blunt, I took off her shirt. And she was just a sore. Her body was just a sore from the inside of her mouth to her toes. So the suffering was extraordinary. But the actual death was comparatively easy in the sense that she didn't seem to be in pain. In the last days, she kind of withdrew. And when she spoke, she spoke about the distant past -- about her parents, about people she was involved with 30 years before. She wasn't focused on the present or any of us. Then she lapsed into a kind of somnolence. And then she died. It wasn't terrible.

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