3,000–5,000 Days
I know my little health issues don’t count for much in a world on fire, with brimstone probably right around the corner. The personal scale is easier to grasp, though, even if it is a little close for comfort.
My recent maladjustment emerged suddenly out of vagueness, like waking up in some dim and foggy classroom with assignments and tests and I can’t remember even signing up in the first place. Dropping the course is not an option.
Looking at cancer as an unpredictably long-term seminar on mortality has been working out pretty well for me so far. I have been, by the National Cancer Institute’s definition, a Cancer Survivor for over ten years. Thinking of it as a course of study gives it value, chemo and all. Everyone who knows me can see that having cancer has helped me become much less of a jerk than I used to be.
I don’t know where my more recent prostate problems will take me. This course began on August 17, 2017 when, after a lovely night out with family, I went into retention, as it is referred to in pee circles.
That was 54 days ago. When it was happening, I was in a form of pain I had never imagined. Finally, after all my efforts only made things worse, I was utterly dependent on whatever help could be found on a little island in the Salish Sea. I love writing that sentence, partly because I like the sound of ‘Salish Sea,’ but more because I can’t feel that pain or that awfulness any more. I can remember that it happened, but mostly I feel great that I handled it, now that I’ve handled it.
Beyond the skill building metaphor is the complicating prospect of dying sometime, how to interpret and use the uncertainty.
My cancer would be back by now if I was normative, if I was right in the sweet spot of the Gaussian distribution that’s drilled into us as the way things go. At the moment, my numbers are getting better if anything.
I took my 72 month Mean Time of Remission seriously back in 2010, but as a concrete possibility, not a prediction. The stats weren’t wrong, I just wasn’t the Mean, this time. And here’s where the ‘magical thinking’ can creep in — I’ll be different, because I am, always have been. I hear that voice and it provides a kind of reassurance, even though it’s just plain wrong.
We can make a difference in our life duration, but our thoughts and behavior are just one factor in a larger equation. As we age, the gap narrows between what will probably happen and what actually happens because there’s just not as much time. I’ve made it to 68 and all the things that possibly could have prevented that didn’t. I feel like it’s reasonable at this point to project a probable remaining life span for myself that I can think of in days. My working number is 3,000–5,000.
I like this range of numbers a lot. It’s big but not too big to imagine clearly. At the low end, it’s the about the amount of time I was in high school and college. Throw in Junior High and Grad School, and that’s what I very well still could have left. Treating every day as if it’s my last isn’t that easy for me. But looking at each one as an irreplaceable piece in a variety pack of 3,000–5,000 feels different. My eight-week Retention-to-Surgery course represents 1–2% of what there is. At the moment it feels like much more than that, but I’m sure even months down the road it will feel like time well spent.
When I speak to high school students about end-of-life, as I have here in San Francisco, once for a full school day, one class after another — I ask them how they would change their life if they knew they had one year to live, and then work my way down to one day. I do it as a ‘House’ medical show and really ham it up; most of them get into it, and at first they bring up exciting stuff like parachute jumping and meeting rock stars. But as time gets shorter, what’s important almost always changes to friends and family.
3,000–5,000 days is like the ‘House’ game. I’m a Mortality Advocate because I can’t figure out any other basis for value than time and what we do with it. If we had unlimited time, like Bill Murray in ‘Groundhog Day,’ we could do everything — moral things, immoral things, it wouldn’t matter. It’s only having a limit that makes anything matter.
Ezekiel Emanuel already took this idea a step further with his 2014 article, “Why I Hope to Die at 75.” It got some discussion going at the time, mostly forms of disagreement. I don’t think people read the article carefully enough, or maybe they went no further than the headlines. Ezekiel Emanuel, esteemed scholar, did not say we should all scarf down some cyanide birthday cake on our 75th. He said, in the October 14 Issue of The Atlantic Monthly:
I am talking about how long I want to live and the kind and amount of health care I will consent to after 75 … I think this manic desperation to endlessly extend life is misguided and potentially destructive. For many reasons, 75 is a pretty good age to aim to stop.
That’s not so different from the 3,000–5,000 Days I’ve made up. A realistic and personally satisfying planning horizon is not a prediction, a self-fulfilling prophecy, or a death wish. It’s a thought-tool that helps me manage my life. There’s more I want to do. What was the point to all the learning, to gaining wisdom, if not to accomplish something that I consider meaningful with it?
Limits help us act in terms of what we value the most. They work best when they’re clear; unfortunately, the most important ones are not. For now, the 3,000–5,000 dot JPG is my working proxy for the duration of the mortality seminar. It feels like enough and it helps me want to keep at it every day.
