I recently met with my oncologist and liver surgeon at the Cleveland Clinic. Arriving back in Oberlin, I ran into Socrates and Glaucon.
Socrates: It is nice to see you, Jed. We were just discussing the matter of your health and whether you now have reason to be philosophically optimistic, pessimistic, or something else.
Jed: Socrates and Glaucon, best of men, I would like nothing more than to discuss this with you. It has now been over a month since my liver surgery. The surgical margins were clear, my liver is returning to its normal size, and I have had no bile leaks, infections, fevers, or other complications so far. Last week I had a CT scan and the radiologist described no visible cancer in the remnant liver, lungs, or anywhere else, though he again raised questions about two enlarged lymph nodes. I’m trying not to worry about those, however, since a surgeon has already evaluated them. All in all my latest news is very good.
Socrates: We also remember that you responded well to chemotherapy before your surgery so you must surely be buoyed by joy and optimism. Now you can put your cancer behind you and return happily to your family and work, secure in the wonderful knowledge that you have heroically faced and defeated this dread disease forever.
Jed: Not exactly, Socrates, for the general statistics on stage IV colon cancer patients are rather bleak even for those who have surgery. More than 75% of us relapse within two years and only 20-25% of people in my condition are still alive 5 years after diagnosis. Even among the survivors, many are battling recurrent or incurable disease and face a life of permanent chemotherapy.
Socrates: I see. Well, then, with those thoughts in mind you must surely be overwhelmed by pessimism. You must be disoriented, dispirited, and suicidal, secure in the horrible knowledge that life is no longer worth living because cancer has taken you from your loved ones and utterly destroyed you.
Jed: Not exactly that either, Socrates. I am simply trying to balance my sense of having made real progress since last August with realism about what may lie ahead.
Socrates: How admirably philosophical. Let me suggest more empirically that your statistics must be dated by at least a few years and may be better than what you say. I’d say that you are also young for a colon cancer patient. And I know that you exercise, read poetry, own a pet, drink green tea made from filtered water and eat organic whole-grain anti-oxidant seaweed pomegranate berries. You have friends and family taking good care of you. All of that must be in your favor.
Jed: Yes, but then again behavioral activity is always of questionable value against poor prognostic features, genetics, and tumor biology. Here, take a look at my pathology report.
Socrates: Hmmm. Jed, I usually claim to know nothing so as to become free to receive exciting new knowledge, but here I confess to being frightened just by the sounds of all this medical vocabulary. Quick, Glaucon, open your laptop and Google some of this diagnostic information.
Jed: Socrates, with all due respect, it is my experience that Google and late-stage cancer data combine to form an ever-intensifying and time-devouring spiral of spiritual demoralization. A treacherous, postmodern hermeneutic field is produced by so many facts, questionable facts, interpretations, statistics, personal narratives, and new and experimental treatments. I have learned a great deal about my disease but have also come to realize that there are limits to what I can know and how I can apply it to my case.
Socrates: So you have rescued angst from drowning in hope and hope from withering in angst, but how does this leave you philosophically? Can you now avoid the paralyzing extremes of optimism and despair, of too much and too little information?
Jed: I don’t know, Socrates, but here is how I’m trying to think. I assume that there are three groups of patients who find themselves in my position. The lucky ones can do whatever they like – drink Scotch and smoke pan-blackened pepperoni – without ever having their cancer return. The unlucky ones can also do whatever they like – drink turmeric infusions while practicing zen yoga and enjoying wheat-grass enemas on shimmering leaves of bamboo – but will never ward off their cancer. The last is the make-your-own-luck group. Without knowing it, these patients have the chance to influence outcome with behavior. Now, since we patients cannot know in advance how big each group is nor to which one we belong, our most logical approach is to hope we’re lucky but to act as if we were make-your-own-lucky. Thus I am beginning four more months of chemotherapy on March 24 — it might make the difference.
Socrates: So you are trying to be neither optimistic nor pessimistic but something else, say, probabilistically practical.
Jed: Yes, and every month or so I’ll try to remember to let you know how it’s going. Glaucon can show you where I’m posting the updates.