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Courage And Hope
David Spiegel, MD

Plato said that courage is knowing when to be afraid. Indeed, serious illness is a reminder that we are not immortal. Those who respond creatively to a life-threatening illness hear it as a wake-up call, a reminder of how time is short and life is precious. They do what matters most while they can, experience the joys of living and loving, and let the people around them know how much they are loved and appreciated. They trivialize the trivial, drop useless commitments, eliminate relationships that are taxing and not worth the trouble and just say no to doing things they think they should do rather than what they want to.

A moving tradition is writing to pass on to family and friends an individual's spiritual legacy, a codification of what that person has learned in life about what has meaning and value. This underscores the importance of feeling embedded in the world of people, using the contemplation of the end of one's life not to deny death but to reaffirm the values of life.

The people talk about and illustrate the will to live in a realistic and meaningful way. They do not demonstrate some artificial determination to prolong life no matter what. They assess life's resources, goals and values. They take stock and see how fortunate they are to have people who care about them and whom they care about. Mind may not triumph over matter, but mind does matter.

Years ago, a clever graduate student taking a statistics course was wandering through a cemetery and realized there were two types of data on the headstones: birthdates and death dates. She wondered if they bore any relationship to each other. Theoretically, they shouldn't. When you die, you die -- period. That was not what she found. People tended to die after their birthdays, not before. The difference was not large, usually several weeks, but was significant. People seem to hang on until after their birthdays or some other special event. This doesn't mean you can make yourself live indefinitely through mental calisthenics, but rather that meaning makes a difference in the course of disease.

Another crucial theme is the power of social connection: no man or woman is an island. Prisoners of war on Bataan kept themselves alive through giving one another lectures, playing together, caring for one another. They develop a special relationship with each other and their God.

In my own field of research, we have found that women with breast cancer help one another enormously through support groups in which they can vent their darkest fears and learn how deeply they can still care about each other. To feel part of a network of caring at a time of serious illness is deeply reassuring. The will to live is not the denial of death. Rather, it is the intensification of life experience which comes when you realize how finite life is.

Be willing to make compromises, find the joy in life, find good support groups, be partners with your doctors. Cancer patient stories make it clear that we are not simply happy or sad and that pleasure is not simply the absence of pain. Illness teaches us that we can be both happy and sad and that even the threat of progressive disease and death can provide a context in which life can be sweeter. One woman with advanced breast cancer once said to me, "All my life I had wanted to go to the summer opera in Santa Fe. This year I went. I brought my cancer with me and it sat in the seat next to me. I loved it."

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