Nobody thinks they will get cancer, until they do. I am now beginning my eighth of 10 rounds of chemotherapy (2.0) for advanced metastasized prostate cancer. It has been almost 4 years since my first round,1 and now I am learning to endure it again, both practically with the physical pain and ontologically with the emotional pain, as I become something of a stranger to myself. I do so as a person who was actively trying not to be disrupted by negative life events and was purposefully avoiding the conditions that might unsettle my life, which Heidegger refers to as “thrownness.”2 As I contend with cancer, I am open to new developments and possibilities and not attempt to escape or deny the reality of my situation. Although I have choices, I choose chemotherapy. I seek to return to what is normal to me because this thrownness causes anxiety. Anxiety, unlike fear, has no object and is considered a kind of emotional illness that compounds the physical sickness of cancer. I must stand up to cancer and liaise well with my health care team; I hope to eventually lead a full, recognizable life once more.
Chemo 1.0 felt like being thrown off a cliff; It forced me to learn how to navigate my experiences, to develop wings while plummeting to earth. The question now, in chemo 2.0, is how to adjust once again.
During my cancer treatments, my re-reflections are guided by Richard Kearney’s hermeneutic wager.3 I prefer a wager over the traditional cancer metaphors that imply a winner–loser paradigm, as well as the carnage associated with war, shrapnel and dismembered, unrecognizable bodies. Making this wager does not mean I am not standing up to and confronting cancer with vigour and intensity. The wager offers dignity with participation, where all the cards are dealt for both cancer and treatments to the person living with cancer, their health care team and family. All play together as a community. The wager is respectful and addresses the risks involved while being fully conscientious of outcomes as an unpredictable event.
I have adapted this wager to learn to live with cancer and its treatments. For me, it comprises 5 reflections: imagination, humility, commitment, discernment and hospitality. Through these reflections, I can deal with the uncertainty that a diagnosis of cancer often requires.
Imagination of a future outcome can be negative or positive. After chemo 1.0, I viewed the future as positive because chemo did what it was supposed to do; not rid my body of cancer, but make it manageable so I could live my life well again. The unpredictability of the wager proved otherwise; my cancer returned. This offered new possible imaginary journeys. Chemo 2.0 might not work and the wager might go the way of the cancer. Or maybe my side of the wager would be successful with a desireable outcome to one degree or another. The third option might be that the wager ends in a draw, where nothing changes, and end-of-life care becomes part of the unimaginable.
The next reflection to consider is humility, which flows from recognizing the necessity of imagination to knowing what I need beyond the biomedical treatments. One thing I discover is the necessity of humour to ease the pain. I can say without hesitation that humour is medicine; when you cannot cure a person of cancer, you can heal them by appeasing their suffering.
It is our commitment within the cancer wager that safeguards us from indecision or denial and ensures our lived existential experience. A leap in faith brings me to a full commitment in acknowledging that my health care team is doing everything they can to help me live with and through the cancer experience. It speaks hope and confidence in those around me, As I develop my wings while being thrown off the cancer cliff, I am not alone. I have access to multiple forms of help and support. This continues to be invaluable for helping me let go of fears and doubts about my treatments, I am able to enter into chemo 2.0 knowing what the adverse effects will feel like with some trepidation, self-empathy and hope.
Discernment adjusts imagination by reminding me that not all possibilities are available to me (for example, a cure) and moderates commitment by reminding me that some wagers’ unpredictable outcomes will evolve in ways I cannot anticipate.
Finally, hospitality tempers discernment to ensure that I remain as loving to myself and others as possible. This reflection prevents fear and anxiety from becoming the driving forces of the leap of faith. Hospitality offers an openness in the face of our natural tendency to fear and exclude the strange, in this case, cancer’s possible outcomes. It also means I need to be open to whatever comes my way: the good, the disappointments, the nervousness as I wait to hear about my cancer status. Being careful not to distance myself from my capacity to self-empathize with my suffering, the gift of hospitality will also help me accept my death with peace and grace if my wager has simply run its course. My metaphorical cards were played with skill, knowledge and determination, and folding them is knowing death is as human as being born.
Reflections and re-reflections need to be welcomed parts of the process. They might be anxiety-provoking, but if we welcome all of these reflections as expected, the weight they carry may lessen or their rawness may dissipate. Taken together, these 5 reflections support and define each other. They are open rather than closed, humble rather than victorious, imaginative rather than unembellished, engaged rather than passive and exploratory rather than closed-minded.
During the quietude of waiting for the next set of scans, I reflect on what might come next. I am anxious, nervous and exhausted, but I am willing to leap again and continue to wager the outcomes. This metaphorical wager may be joyful and exuberant at times, while realistically, I also know it may not play out in my favour. In this context, however, I am not ever going to be a loser of a battle, but rather a risk-taker and believer. It is the very uncertainty of the wager as it plays out, again and perhaps again, that lifts hope.
Footnotes
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