This week we bring you the firsthand testimonies of two academics confronting cancer. While significant differences exist between the cases of Kate Bowler, the Duke Divinity School professor and historian of American religion, and Paul Kalanithi, the recently departed Stanford neurosurgeon, each has written vividly about what Christian Wiman calls the “shattering experience” of confronting one’s mortality.
We start with Kate Bowler’s recently published opinion piece, “Death, the Prosperity Gospel, and Me,” which does not bury the lede. It begins:
On a Thursday morning a few months ago, I got a call from my doctor’s assistant telling me that I have Stage 4 cancer… I am 35. I did the things you might expect of someone whose world has suddenly become very small. I sank to my knees and cried. I called my husband at our home nearby. I waited until he arrived so we could wrap our arms around each other and say the things that must be said. I have loved you forever. I am so grateful for our life together. Please take care of our son. Then he walked me from my office to the hospital to start what was left of my new life.
For Bowler, there is irony as well as tragedy in her illness. Young though she is, she has recently published an authoritative and well-received account of the emergence of a distinctively American form of the Prosperity Gospel, which she defines as “the belief that God grants health and wealth to those with the right kind of faith.”
The key term here (and the title of Bowler’s book) is “blessed,” which Bowler says can interpreted either as “gift” or “reward.” Understood within the logic of gift, being blessed is a way of focusing attention away from the merits of the individual, whatever those merits may be: If I am blessed, it is because someone or something has made me so. Not so in the logic of reward. As Bowler makes clear, for believers in the prosperity gospel to be “#blessed” is to be on the receiving end of a contractual relationship with God. The prosperity gospel, in her view, “revolutionized prayer as an instrument for getting God always to say ‘yes.’” Moreover, “it offers people a guarantee: Follow these rules, and God will reward you, heal you, restore you.”
But cancer defies easy explanation. For Bowler, it has “ushered in new ways of being alive.” Whereas “the prosperity gospel holds to [the] illusion of control until the very end,” Bowler describes her experience differently:
The most I can say about why I have cancer, medically speaking, is that bodies are delicate and prone to error. As a Christian, I can say that the Kingdom of God is not yet fully here, and so we get sick and die. And as a scholar, I can say that our society is steeped in a culture of facile reasoning.
Though he is not as comfortable as Bowler making use of theological categories, a previous New York Times piece by Paul Kalanithi (as well as the book that followed it) highlights what Kalanithi elsewhere calls the “pluperfect state” that comes with a terminal diagnosis, which he received as his medical training came to an end. Titled “How Long Have I Got Left?,” Kalanithi reflects on his experience “traversing the line from doctor to patient.” As doctor, Kalanithi was well versed in the best practices of delivering bad news:
Be honest about the prognosis but always leave some room for hope. Be vague but accurate: “days to a few weeks,” “weeks to a few months,” “months to a few years,” “a few years to a decade or more.”
On the receiving end of such news, Kalanithi found himself longing for more than the “ounce of certainty” he could ascertain from scans and scientific knowledge. Yes, this cancer would kill him, but as he says, “the range of what is reasonably possible” was remarkably wide.
The path forward would seem obvious, if only I knew how many months or years I had left. Tell me three months, I’d just spend time with family. Tell me one year, I’d have a plan (write that book). Give me 10 years, I’d get back to treating diseases. The pedestrian truth that you live one day at a time didn’t help: What was I supposed to do with that day? My oncologist would say only: “I can’t tell you a time. You’ve got to find what matters most to you.”
Living with this degree of uncertainty forced Kalanithi to reevaluate his basic relation to time. In a beautifully personal piece for the Spring 2015 issue of Stanford Medicine called “Before I Go,” Kalanithi compared the rhythms of his life with cancer to his experience in the operating room:
The funny thing about time in the O.R., whether you frenetically race or steadily proceed, is that you have no sense of it passing. If boredom is, as Heidegger argued, the awareness of time passing, this is the opposite: The intense focus makes the arms of the clock seem arbitrarily placed. Two hours can feel like a minute. Once the final stitch is placed and the wound is dressed, normal time suddenly restarts. You can almost hear an audible whoosh. Then you start wondering: How long till the patient wakes up? How long till the next case gets started? How many patients do I need to see before then? What time will I get home tonight?
But cancer changes all that. “Time,” in this new state, “is double-edged: Every day brings me further from the low of my last cancer relapse, but every day also brings me closer to the next cancer recurrence—and eventually, death. Perhaps later than I think, but certainly sooner than I desire.” This led Kalanithi to a basic confusion about verbs and their tenses. “Verb conjugation became muddled. Which was correct? ‘I am a neurosurgeon,’ ‘I was a neurosurgeon,’ ‘I had been a neurosurgeon before and will be again?’”
The testimonies of Kate Bowler and Paul Kalanithi are just that—testimonies. Their power resides not in their capacity to speak for the whole of humanity or to some generalized sense of being frail or sick, but to communicate in concrete terms their own encounters with their own mortality. Illness, in this way, can only be described, never fully shared. And yet, what lives in the words Kalanithi and Bowler have provided for us is the noble attempt to welcome others into what Kalanithi calls the “angst of facing mortality” that has “no remedy in probability.”