The Grace Walk

By Robin Schoenthaler, MD

Over time she’s become accustomed, in a bemused sort of way, to the slam-shut silence that descends when she mentions to new acquaintances that she’s an oncologist. It seems it’s an occupational hazard for a lot of physicians; certainly gastroenterologists and urologists come in for it, too. It’s just a fact that nothing dims a cocktail party’s volume setting like the casual comment that you specialize in anal surgery or leukemic kids.

So over time she’s come up with an acceptable sound byte that rapidly reassures new acquaintances that she’s just a regular gal who happened to get involved with nether regions and unspeakable tragedy for all the right reasons.

She has a little template of sorts, a quick response to the quasi-horrified, so when laypeople ask her, “But how can you bear to be a cancer doctor?” she can chat for a moment about the steady pace of oncologic advances, the satisfaction of having a measurable impact, and the honor of witnessing total strangers coping with the big issues. And then she changes the subject.

But she’s getting older, and more and more she’s tempted to add, “Because cancer opens doors that dropping dead simply doesn’t allow.”

Thus far she’s resisted the temptation to debate the merits of different demisemodes at dinner parties, but increasingly she contemplates the pros and cons of known-impending-cancer deaths vs. out-of-the-blue sudden deaths.

She finds herself wondering if cancer might not just be the answer.

She pulls the car over on a highway, intently listening to an NPR story reporting that more than eighty percent of oncology nurses would choose to die of cancer. Not heart attacks, not car accidents: Cancer.

Increasingly, she can see the nurses’ point. Every year that she deals with the dying she becomes more aware of the “silver side” of cancer, reasons to prefer slow death from cancer to sudden death via blood clot or car wreck or an unannounced MI while on a boat all alone.

On the other hand, she’s had a couple of brushes with a cancer diagnosis herself (that terrifying mammogram call-back springs to mind) and the mere thought of a mutating heat-seeking missile in her blood led to hyperventilation and night sweats. And yet increasingly she believes she would vote “cancer” if her deathbed had multiple choice.

She knows part of her reasoning is that she gets to see the “good” cancer deaths. The ending doesn’t terrorize her the way it did twenty years ago, knowing that nowadays cancer deaths can be painless and peaceful, accompanied by the magic of the morphine drip and the godliness of a good hospice nurse.

And she’s learned from her patients that a cancer diagnosis can give people time to tidy up life’s loose ends, putting one’s proverbial affairs in order. But she’s learned from other patients (mostly those horrible unexpected deaths via pulmonary emboli) that sudden deaths can leave a family gaping, gasping for more, grasping for the words they would have could have should have said if only, only they had known.

But lately (probably because she’s getting older), she’s been learning from her friends, and most of it has been from individual friends and individual moments. It’s been seeing up close and personal the moments of presence and transcendence the terminal diagnosis seems to allow. Lately she’s been seeing them as moments of a grace-walk.

She remembers her first friend walking the grace-walk. A thirty five year old mother of toddlers, Stage II breast cancer, she went from shaking and shrieking to arranging a “Say Good-bye To My Hair” party. She provided the venue, her friends provided the purple wigs; and her village was transformed from terrified bystanders wringing their hands to a cadre of clowns, encircling her with laughter and grace.

More and more she sees that the diagnosis of cancer allows others to chance to gracewalk, too, to give with whole hearts and larders. A single lump in a breast and total strangers console and compare scars. The Ladies’ Auxiliary fires up the casserole brigade, carefully substituting soy where they can. Acquaintances separate like cream on the back porch with the good and able friends rising to the top.

None of this happens with osteoporosis or high blood pressure. It seems to be the enormous visceral impact of a cancer diagnosis that allows the cancer-afflicted to have an impact on their community in a way that just doesn’t happen with benign disease.

She sees her friends transform her views of the disease simply by grace-walking into the grocery store, tall and bald and fully alive. Or when they sit and talk and rock and gaze out kindly at a future wildly different than anything any of them had imagined before and that all of them try to picture now. Or while they keep journals or essays or send out weekly emails, giving a clear-eyed view of each rocket-fueled step along the path.

She often thinks of another neighbor who stood at her church’s pulpit three weeks before she died of breast cancer at 44. She spoke straight to the heart of her congregation, her about-to-be-widowed husband, her two young sons. Her friend described what it was like to be days from death and how her goals had grown simpler at the same rate that her cancer grew more complex ~ first to be cured, then to be well, then to be pain-free, then to be with family, then to see her oldest son’s birthday (she did), then to see her youngest son’s birthday (she didn’t). “Hooray for today,” she said, “Hooray for today.” A pulpit grace-walk that seared the congregation.

She remembers a cancer colleague, cut down in his prime and in agony, kidney cancer to bone, who wrote his own eulogy. His words were intoned in the untrembling voice of his best friend at his funeral: “I’ve had a great life,” he wrote. “I’m dying young, but I have no regrets. I thank you for all for this great wild precious ride.” For months afterwards she thought of every word of his grace-walk.

Over the years she sees sudden deaths that knock a family flat, whereas sometimes with cancer the families start to hone the tools they’ll use again to prop each other up during the aftermath. It’s become clear to her that everyone has so many untied shoelaces in their lives and so little motivation to lace them up tight. It seems it’s only cancer that can on occasion provide the catalyst to tie the shoestrings with a double knot. Is there a more precious gift than the chance to leave knowing you have lessened the odds of a loved one later tripping?

Another neighbor of hers springs to mind, another young mother; metastatic lung cancer at thirty-five, and no, she never smoked. From the start she knew her remaining time would be measured in months and she spent virtually all of that time in a grace-walk with her young son.

A few days before the end, her son brought her his copy of Make Way for Ducklings. She told him that reading that book to him as a toddler was one of her most precious memories, and she told him where they had sat, and in which chair, and what the light had been like, and how when he sat on her lap he rubbed her arm over and over, her left arm, while she read.

He sat down and read it to her right then, at the bedside, at the deathbed, and then ran out to play. After his Little League practice that evening, he read it to her again and so it went through the next few days. He read to her when she was sleeping and he read to her during the dark hours of his mother’s coma.

She is now convinced that the words of Mr. Mallard may well have been the last words her friend heard. Certainly the last thing she felt was her ten-year-old son rubbing her arm, her left arm, over and over. This must be why she’s with the nurses. “Everybody dies,” her kidney-cancer friend had said the bleak black day when he was given half a year to live. “Everybody dies.” So if she has to die but got to choose, she thinks now that she’d take the one where you have half a chance to wear a crazy wig or tie the shoelaces up snug, where you can write emails and sermons and know that people will be listening with broken but wide-open hearts, where you have time to let your children know every little thing you ever loved about them, where you can maybe follow in the footsteps of her patients and her friends and leave behind a transforming legacy of walking talking grace, and where you might get to sail away with your son rubbing your arm, your left arm, over and over, until the book is done.
Originally published in Worcester Medicine, Winter 2006.
Reprinted with permission

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