Lydia's Cancer, and Atheist Philosophies of Death

This piece was originally published on AlterNet.

I write a lot about atheist philosophies of death.

I've written about how loss, including death, is necessary for life and change to be possible. I've written about death as a natural, physical process, one that connects us intimately with nature and the universe. I've written about the idea of death as a deadline, something that helps us focus our lives and treasure the people and experiences we have now. I've written about the idea that our life, our slice of the timeline, will always have existed even though we die. I've written about how things don't have to be permanent to be meaningful.

In the last few months, I've been dealing with some of death's harsher realities.

So I've been thinking a lot lately about how atheism, and humanism, can help us deal with death -- and with life. Not just in an abstract philosophical sense; not just in a "creating a meaningful frame for our lives" sense. I've been thinking about how we can apply atheist philosophies in a practical way. I've been thinking, not just about how these philosophies can help us face death, but about how they can improve the way we live our life.

Our cat, Lydia, was recently diagnosed with cancer. Now, if you've ever had pets, you know: when they get sick or injured, or when they die, it's obviously not as serious or traumatic as when a person we love gets sick or injured or dies -- but it's not trivial, either. It's a big deal.

So our cat Lydia was recently diagnosed with cancer, and it's been very difficult on both me and my wife Ingrid. And it's been especially difficult because we've been having to make lots of difficult decisions, often with limited and incomplete information.

Lydia's not so sick that our decisions are all really obvious -- and she's not doing so great that our decisions are all really obvious, either. She's kind of in the middle. She's been having a hard time a lot of the time, but she's been doing okay a lot of the time, and there's reasonable hope that, with treatment, the cancer will go into remission... or at least, that she'll have a few more good months. And our information has been very incomplete. Tests on the cancer have been inconclusive, and we didn't know at first whether the cancer was a slow- growing kind that would very likely respond well to milder treatment, or a faster- growing kind that would need aggressive, difficult- to- tolerate treatment, with real uncertainty about whether it would even work. One test even suggested that she might not have cancer at all, and that the positive cancer tests might have been mistaken. As a friend who also has a sick cat put it: Rollercoaster is the new normal.

Plus, she's neither a very young nor a very old cat (she's thirteen), so the questions about how much more time we can give her, balanced against how much suffering the cancer treatment will cause her, are very iffy. Even if she didn't have cancer, she could only have a few more months, or she could have many more years. And she has other medical problems, with her appetite and digestion, which have been making diagnosis harder. Is her poor appetite and weight loss a result of the cancer, or the digestion problems? Did she respond so badly to the chemo because her digestive system is so screwed up, or because she really can't tolerate it?

And all of this is making decisions about her care really, really hard. The last few months have been a parade of difficult, often wrenching choices, on an almost daily basis. Should we stop the chemo that seems to be making her sick... or keep going? Rush her to the emergency vet when her appetite drops... or keep an eye on her and see how she does? Hold off on the cancer treatment altogether until we can get the digestive stuff under control, and take the risk that the cancer will advance too far to be treatable... or pursue the cancer treatment, and take the risk that the resulting loss of appetite/ weight will make her already poor health even more fragile? Pursue aggressive surgical options for the digestive problems, in the hopes that it'll make her feel better and make the cancer treatment go better... or don't put her through that trauma, since she has cancer and may not have that much time left anyway?

It's been a parade of small, difficult decisions, all framed by one very large, very difficult decision: When do we keep pursuing treatment, and when do we let go?

But there is one thing that's been making all our decisions easier.

And that's that we accept the inevitability of her death.

We understand that, someday, Lydia is going to die. If she doesn't die of the cancer in the next few weeks/ months, she's going to die eventually. Of the cancer -- or of something else.

Lydia is mortal. She's an animal, and all animals eventually die.

So when we've been looking at these hard decisions, we haven't been looking at them in terms of, "Is she going to live or die?" We've been looking at them in terms of, "When is she going to die?"

Does she have a few weeks, a few months, a few years?

We understand that, someday, she's going to die. We understand that we can't make her live forever. We understand that her time here is limited, and that all we can do for her is to make that time -- whether that's a few weeks, a few months, a few years -- as happy as we possibly can.

So when we're making decisions about treatment, we can look at them with frankness and clarity. We can ask questions like, "Should we give her a somewhat traumatic treatment, for a decent chance at a few more happy months/ years... or should we drop it, and give her a few weeks/ months of relative peace and comfort?" That's not an easy question, and the balance shifts back and forth almost every day: with new information, and with new responses to treatments, and with new developments in Lydia's own mood and health. But we can face it directly. We don't have to dance around it.

And this isn't just about our cat.

We understand the same thing about ourselves.

We understand that we, ourselves, are going to die. We understand that our own time here is limited. We understand that all we can do for ourselves and for one another it to make that time -- however much time it is -- as happy and joyful and meaningful as we possibly can.

And so, when it comes time for us to face these difficult decisions about ourselves and each other, I think we'll be ready. If one of gets (for instance) cancer, we'll be able to ask questions like, "Would I rather face a traumatic and horrible few months for an X% chance at a few more years... or would I rather let go and make my last few months really count?" And we'll be able to answer those questions based on a candid, hard-headed evaluation of how horrible the horribleness is likely to be, and how much time we'd probably have left even if everything goes perfectly, and how much fun that time would be likely to be, and what the likely value is of that X percentage.

We'll understand that the questions won't be, "Am I going to live or die?" We'll understand that the questions will be, "When will I die?" And we'll be able to make our decisions accordingly, with frankness and clarity.

Now, at this point, you might be wondering what any of this has to do with atheism. You might be thinking, "But religious people know that their pets are going to die! They know that the people they love are going to die! They even know that they themselves are going to die! They disagree with atheists about what happens after we die... but they know that death is real, and inevitable. What does making clear-eyed choices about death and life have to do with atheism?"

And that's a fair question.

But I recently saw some research that gives an answer to this question. There was a study, published in the Journal of the American Medical Association in 2009, showing that, among terminally ill cancer patients, those with strong religious beliefs who relied on their religion to cope with their illness were more likely to get aggressive medical care in the last week of their life.

In other words: People who are most strongly attached to a belief in an afterlife are more likely to try to delay death when it's clearly imminent.

That doesn't make any logical sense. If people believe in a blissful afterlife, then logically, you'd think they'd accept their death gracefully, and would even welcome it. But it makes perfect sense when you think of religion, not as a way of genuinely coping with the fear of death, but as a way of putting it on the back burner.

The dominant way we deal with death in our culture is religious. And our religious culture deals with death by pretending it isn't real. Religion deals with death by pretending it isn't permanent; by pretending that the loss of the ones we love is just like a long vacation apart; by pretending that our dead loved ones are still hanging around somehow, like the dead grandparents in a "Family Circus" cartoon; by pretending that our own death is just a one-way trip to a different place. Our religious culture deals with death by putting it on the back burner, by encouraging people to stick their fingers in their ears and yell, "I can't hear you, I can't hear you, I can't hear you!" (This is backed up, again, by the JAMA study, which also showed that "a high level of religious coping was also associated with less use of end-of-life planning strategies, including do-not-resuscitate orders, living wills, and appointment of a health care power of attorney.")

So when religious people are faced with the harsh realities of death -- and with the possibility that their beliefs might be bogus and that death might really, truly be the end -- they're often not prepared. They haven't had to think about the inevitability of death, and its finality, and what kinds of choices they would make when faced with it.

Hence, the the lack of practical preparation for death... and the pointlessly aggressive medical care in the last week of life.

Atheists, on the other hand, have had to come up with ways of dealing with death more or less on our own. Like anyone who rejects the dominant culture, and who rejects the default answers to hard questions that get spoon-fed us by this culture, we've had to come up with our own answers. The same way that LGBT people are forced to think about sexuality and gender; the same way that vegetarians are forced to think about the ethics of food... atheists are forced to think about death, and what kind of value life might have when it's brief and finite. If we once had religious beliefs about an immortal afterlife, letting go of those beliefs forced us to think about death, and to face its finality, and to come up with ways of coping with it. And even if we were raised non-believers, the religious views of death are so ubiquitous in our culture that they're impossible to ignore... and non-religious alternatives, to put it mildly, aren't. Atheists have had to come up with these alternatives more or less on our own. (To be fair, some religious adherents have thought carefully about these questions too, the way some straight people/ cisgendered people/ carnivores have thought carefully about sexuality/ gender/ food ethics... but being an atheist means having that thoughtfulness thrust upon us, whether we like it or not.)

So when the subject of death arises, atheists can't evade it. We can't paper it over with a Band-Aid of "Well, we'll see each other again on the other side," with no careful thought about whether that other side is remotely plausible, or whether it would be desirable even if it existed. And every time we hear people talk about Heaven or angels or past lives or their loved ones being in a better place and looking down on them right now, we're reminded: "Oh, yeah. We don't think that. We think that when we die, we die forever. We don't think our dead loved ones are with God. We think that they're fucking dead." We have to face death a little bit, every day of our lives.

It's like an inoculation.

So when it comes time to face it for real, we're ready. Of course we're frightened by it; of course we're upset by it; of course we want to delay it if we reasonably can, for as long as we reasonably can. Life is precious, and of course we grieve for its end. But it doesn't take us by surprise. We've had time to think about it. We've had time to think about questions like quantity of life versus quality of life, and what we personally think about how these balance out. We've had time to think about questions like what makes life meaningful even though it's finite... and how to make that meaning still be meaningful, even when that finiteness is looking very finite indeed.

And so when our pets get sick, or when our parents start to get frail, or when we're facing hard decisions about our own life and death... we're not caught off-guard. We can make calm, informed, evidence-based choices that are in keeping with our deepest and most treasured values, and that aren't just frightened, reflexive reactions to the single undeniable reality of our life.

When people with life-threatening illnesses like cancer or HIV are given a good prognosis, they're sometimes told, "You'll live long enough to die of something else." That may sound grisly and morbid to some. But to me, it's oddly comforting. It offers the comfort of the solid foundation of reality. It offers the comfort of understanding that yes, we're going to die someday... and so, armed with that understanding, we can make good, thoughtful choices about our death, and about our life.

If you're a believer who's questioning your beliefs, leaving your religion does mean facing the finality and permanence of death. That can be a hard pill to swallow. But when I think about those religious believers frantically pursuing aggressive and pointless medical care in the last week of their life... it seems like a bargain.

Comments

[Locutus7]

This was yet another insightful post. I have this conversation with a semi-believer all the time; he has given up most religious beliefs but clings to the "hereafter."

He balks when I attempt to pin down the details: what precisely survives after death, are our "souls" younger embodied versions of ourselves or do they carry the appearance of the person at the time of death? And do the surviving souls wear clothes or are they naked?

Much simpler if you acknowledge that we return to star-stuff.

[Martha]

My Dad has been diagnosed with ALS. He's a sweet, intelligent, always-put-the-poor-first, God-can & does-intervene-in-my-life-because-of-Quantum kind of Catholic. I'm not exactly out to my family as an Athiest. I go to the Unitarian Church (sometimes) & allow my Dad to think of my ideas about religion as ditzy. The thing is, a couple years ago he self-published a book of poetry, wannabe Thomas Merton kind of poetry. There are intstructions at the beginning to his children & grandchildren about how to read 1 poem a day and then think about it. The point is clearly that sharing his personal experience of God is going to lead us back to the true faith. One of my sisters outright refused to read it. I've been putting him off with comments like "I read a couple & they're OK." Now it looks like I ought to read the whole thing & say something about it, darned if I know what. Of course I can see that my problem is trivial compared to his, but, well, as
Pooh says, Help & Bother!

[Locutus7]

Martha,

You could tell your Dad that everyone has their own conception of god - and that some don't even believe in one - but of all the religious perspectives you have known, his is one of the most interesting.

Just a thought.

[John the Drunkard]

The loss of a cat can be worse than the loss of a close person. With the cat, the hard decisions fall on us, we have to act 'in loco deus.' This is the price we pay for our special custodial relationship with the beasts.

I know that I suffered more pain from Abigail's life ending as I held her in my lap that I did from the loss of my marriage, my home and my job--all of which came in the same half hear.

I have shed more tears over Abigail than if have for my mother.

[Linda H.]

Thanks for your blog. It is a wonderful resource of well-thought-out arguments on pertinent topics.

I searched your blog for "learned optimism", and found nothing.( I did read your terrific article, "Lydia's Cancer, and Atheist Philosophies of Death." I agree that atheism is a much healthier perspective on death than traditional Christianity. Of all people, in my experience, conservative Christians are the most terrified of death, other than at the moments when they are reciting their beliefs about salvation and Heaven. It makes sense that they put it out of their minds, and therefore are unprepared for it. But another interpretation is that everyone who believes that God sends most people to hell subconsciously fears death, because they can't be sure of of their own salvation. That is one reason why traditional Christianity used to work pretty well to oppress people into conformity.

I wonder if you have addressed the idea that a religious belief could function as "learned optimism?" I have embraced Jesus as my Savior, not because I believe anything like what my parents did/do, but because of an experience I will describe below, and because my upbringing was framed in Christianity.

To understand this, you have to know that I was raised Southern Baptist in the 60's. I rejected Christianity as harmful, maybe evil, when I was in my teens. In college and in my twenties, I became very interested in Eastern religions and philosophies. Marijuana had shown me that dropping certain fears and tensions that I had held continuously for many years, allowed my mind to observe and entertain delightfully fascinating new ideas. Meditative disciplines gave me some power over anxiety as well. I found that when I suspended rational judgment and read certain sacred texts, I gained more traction. In my experience, all spiritual paths that have a mystical component can be used in this way.

Getting control of anxiety is a critical issue for me. (Though my current best estimate is that I actually can't control it, working with it is and has been a beautiful, rewarding process.) I have had to deal with moderately severe panic attacks for much of my life. In the course of the last really bad one I had, I felt that I might immediately die and go to hell. (This was despite having totally rejected that possibility with my rational mind many years back.) I was beside myself with terror. I tried my childhood religious incantations, aware that I was never more sincere than in that moment. But I still was terrified, thinking the terror alone was enough to cause a heart attack in that moment. I then had the following stream of thoughts: I can't know if God is going to send me to hell. But in this moment I am alive, and not in hell. It is not going to help me in any way to worry whether God is going to send me to hell. Letting go of the worry, fully and finally, is by far my best course of action. I have fulfilled all the requirements of the fearful superstition I was imbued with (that God sends people to hell, and to avoid that one must accept Jesus as Savior.) There is nothing more I can do, but let go of the fear.

I did not go back to believing any of what I call the superstitious propositions of Christianity. But I remembered that Jesus is my Savior - the loving Jesus that the littlest Christians are allowed to have for a few years. I transformed the superstition into a useful mantra. It works pretty well for me. And I want to evangelize - everyone who had the same superstition and terror drilled into them. So I am working at that, in connection with a liberal church. In this way there is hope that Christianity can be redeemed. Radical, real love is a tremendous power for good, as anyone who as contemplated what love is, knows. Tradition, ritual, music, and mutual caring make for a healthy community. In a way, I am a sincere Christian Atheist, as I don't believe in God as described by fearful and superstitious people. But the language of religion comes to me to describe my reality. There is no final, ultimate division into which reality is permanently cut. Reality is the one God. The question is, whether that reality is evil, good or indifferent to me. My life goes on, and I keep choosing to believe and act as though it is good with me. That makes my life possible, as I would have killed myself with anxiety otherwise.

[Randi]

What happened with Lydia?

[Nurse Ingrid]

@ Randi:

Lydia passed away a few weeks after Greta wrote this piece. Here is the obituary:

http://gretachristina.typepad.com/greta_christinas_weblog/2010/12/lydia-1997-2010.html

Thank you so much for your thoughtfulness.