I've got breast cancer and I don't want to live

I wanted to die even before I got sick. But my family will kill me if I just give up hope!

Published March 8, 2007 11:45AM (EST)

Dear Reader,

This morning some good news arrived. Remember last March a 40-year-old man wrote saying he had been diagnosed with colorectal cancer? He writes today to say that over the last year he has undergone surgery and chemotherapy and is now cancer-free. We all wish him the best in his continuing recovery.

In August I lost my father-in-law to colorectal cancer. There is a reasonable chance that if he had followed the recommended screening guidelines for colorectal cancer detection and prevention, he would be around today, berating the rest of us for not following the screening guidelines. As it is, he's gone.

So I'll do the berating now: Get screened!

Coincidentally (I don't plan these things!) it's March and that makes it National Colorectal Cancer Awareness Month. So another word on this topic is warranted.

I am of the age at which a colonoscopy is recommended. So I had my first colonoscopy this month. I tell you, it was no big deal. It was a piece of cake. The day-before preparations were a breeze. Doctors have made significant progress in improving the way one prepares for the procedure. Some preparations used in the past were fairly unpleasant. But in my case there was just some Gatorade to buy, and some stuff to mix in it, and a lot of hanging around the house drinking this stuff and going to the bathroom. What could be easier than sitting around the house drinking Gatorade and going to the bathroom?

The actual procedure the next day was a breeze, too. They gave me some drugs and I lay down on my side and had a nice restful sleep. I don't remember a thing. And there were no unpleasant aftereffects.

So do the math. On the one hand: the risk of colorectal cancer. On the other hand: a day off work and some good intravenous drugs. I'll take the day off work and the drugs.

Now, I should say that this is just one man's experience. But this one man is fairly squeamish. I'm no trouper. Just so you know.

So see your doctor and make an appointment for whatever screening is appropriate. And no matter what age you are, if you have any kind of symptoms -- our friend who survived cancer was 40 -- or have even the slightest notion that there might be a problem, get it checked out.

Now, on to today's letter, which seems to be less about cancer than about the lack of a desire to live.

(Concerning suicide: A column that ran last March on the subject of the best method for a painless suicide continues to be read by a surprising number of people every day (we have the numbers!), many of whom seem to be looking not for my impassioned argument against suicide but, literally, for a practical how-to --which I'm not going to provide. I'm just not into it.)

Dear Cary,

About a month ago I was diagnosed with fairly advanced breast cancer. Surgery is done and I'm looking at chemo starting next week. I realize I am very lucky to have insurance, for the doctor to have noticed the tumor and raised the alarm, etc.

Problem is, I really don't want to live anymore. I didn't before the cancer diagnosis. I'm proud of the modest financial success I've obtained, but I dislike my career, I'm lonely, and frankly I just want to go to bed and not wake up. I have my will and so forth in order, with lots of life insurance for my favorite charities.

But with the diagnosis, I have to go through with the treatment -- I have a small family, but they would be furious if I bailed.

I don't know what to do. This is greedy of me, taking advantage of these treatments when, if I had found the lump on my own, I'd be dead already. I don't know what to do.

Ready to Go

Dear Ready to Go,

Surrounded as we are by life of all kinds, perhaps we find it easy to devalue life as a phenomenon, to forget quite how rare and fantastic it is in the universe. After all, many life-forms, particularly urban ones, are nothing but impediments to our dreams and locomotion. Life has a life of its own, and it is often just in the way.

But if you were to spend some time tonight lying on your back in an open field staring at the immensity of the night sky, and if you were to imagine the vast, chilly silence across which there is apparently nothing at all, or at least very, very little ... if you were to contemplate the unimaginable emptiness of uninhabited space and then multiply that by an infinity of zeros (to represent the incomprehensible nothingness of no consciousness whatsoever), then after a while contemplating this, you might be however weakly stimulated by a tiny voltage of recognition and bring into being some however infinitesimal appreciation of the miracle over which you have been granted a brief and undemanding stewardship.

Maybe not. I'm just thinking, there may be ways to shock yourself out of this awful lack of awe.

I got an angry letter a couple of weeks ago, in response to that Painless Suicide column mentioned above. To the writer of the letter, it was as though by writing a column titled "Painless Suicide" I had indulged in false advertising by not providing the concise, nuts-and-bolts how-to the letter writer had been searching for. "Just answer the *$#% question," the writer said. "What's the most painless method?!"

I guess I have this blind spot where it comes to death. I'm against it. And so, mostly, I'm against suicide. I'm the side of the living. I watched my father-in-law die of cancer in August, and my dear uncle die of cancer in January. These men wanted to live. They fought for life.

I recognize death's power. But I consider it the enemy, voracious and amoral, hungering for my breath. "Rage, rage against the dying of the light." That's how I feel about it.

And when the enemy gets into my own brain, telling me that suicide is a good idea, I figure it's time to fight the enemy inside my own brain. So how do we modern people fight enemies inside our own brains? With medicine and philosophy and science and courage.

So I wonder: When death gets in our brains and begins its dark bossa nova of seduction, what are the countermeasures, aside from drugs that treat depression? Why do I envision a man in the desert thirsting for some water? Why do I picture a battlefield covered with the dead? What if, as suggested above, overfamiliarity with life itself breeds contempt for the living? What if the shock of loss might ignite a new craving for the simple heartbeat and hunger of quotidian existence, the dull old day-to-day that most of us prefer -- some unthinkingly, some consciously -- to the unknowns of death. I think of my uncle lying in his open casket there in the dining room of the family home -- I contemplated his corpse a good deal over the three days that he lay there. I think of my aunt berating him as he lay there: Why did you have to die!? Contemplating his corpse, and realizing how much he wanted to live and how bravely he fought back against inevitable death, I realize it did make me cherish life a little more.

Indeed, there have been times when I have lost the will to live, when consciousness itself was nothing but bleak pain. But it eventually went away, with treatment or perhaps on its own, as a beast grows bored with its victim and moves on to something more interesting to torture. It may return. One never knows. I don't know what else to do except trudge on.

So do me a favor, please, Ready to Go: Look into the possible effects of the drugs you have taken in conjunction with your cancer. Also look into any possible causes of clinical depression that might have been going on prior to your diagnosis. Depression makes people think they want to die. But depression is temporary, while death is permanent. Depression can be cured, but death is incurable.

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