A stay of execution


The Guardian, 11 December

Figures released by the Office for National Statistics confirm that more people are recovering from, or living longer with, cancer. Welcoming the news, Mike Hobday of Macmillan Cancer Support observed that for many patients, “cancer is now a long-term condition rather than an acute disease”. And there’s the rub. Surviving, it turns out, is a complicated, demanding business, posing fundamental questions for the individuals concerned and for society as a whole.

I speak as an example of the statistical trend: five years after being diagnosed with multiple myeloma (cancer of the bone marrow) I find myself enjoying a period of remission. An enormous relief, of course, but not as straightforward as people imagine.

When you’re first diagnosed with cancer, you think: why me? Why have I been singled out for this trial? Then when you survive, you think: why me? Why have I been granted a stay of execution denied to others who happen to fall on the wrong side of the statistical median? How can I prove worthy of this reprieve? How do I make the best use of this precious extra time? And how much of it will there be?

Some would advise me that in these circumstances it’s best to see the glass as “half full” rather than “half empty” – advice that presumes it’s merely an act of will to see it half full, and a failure of will to see it half empty, that makes a virtue out of describing absence or need as satisfaction. Nor does it help to try to see the same glass as simultaneously “half full” and “half empty”. At any moment those may not be the proportions and everything depends on what the glass is half full with and what it’s missing. The half full doesn’t necessarily compensate for the half empty.

An encounter with one’s mortality is supposed to “put things in perspective” or teach us a lesson in “proportion”. In some ways it has done that for me, but it doesn’t magic away the frustrations of daily life. It doesn’t suddenly tame deep-seated drives and desires (“proportion” doesn’t apply to them). It doesn’t lessen the weight of social injustice. The injunction to “rise above” grievances becomes, in the end, another artificial imposition, an exercise in denial.

The same can be said of the commonplace about “living every moment to the full”. Yes, it’s a good idea while you can to seize the day, but it’s also a vanishing horizon, a desire that can never be satiated, and after a while just another source of anxiety. “What’s wrong with me? I’m not getting the most out of every moment!”

Not everyone who survives cancer can fully return to who they were previously, nor should they be expected to. We survive but usually not unscathed. In many cases, what ensues is a struggle with fatigue, immobility, disability, depression, and/or a shifting array of symptoms and side-effects, not to mention juggling medications and hospital appointments. When all this is compounded by lack of money, the counsel to “live every moment to the full” is a very unfunny joke.

Even as we enable people to live longer we take away from them the means to live that life as well as it can be lived, never mind “to the full”. In our social Darwinist order, the increasing survival-of-the-not-fit is an awkward embarrassment.

I’m alive now not just because of scientific advances, but because those advances were made available to me by the NHS. In the United States, the life-extending therapies I’ve received would have been financially devastating. Here we’re spared the charges and the anxiety and bureaucracy that accompany them. But the undermining of the NHS by cuts, fragmentation and privatisation place all that at risk. The (often expensive) care we continue to require, long after our initial treatment, is in jeopardy.

On top of that, cuts in benefits and services will make it more difficult to survive with a modicum of dignity. We’re to be handed over to the tender mercies of a deregulated labour market that offers little to anyone dealing with a recurrent illness – even if they’re ruled “fit to work” by Atos. As collective provision is withdrawn, or subject to household means-testing, our survival becomes a burden for those close to us, a blessing mixed with hardship.

Here the personal and political challenges come together. Anger against the injustice of one-sided austerity ought not to be suppressed because the glass is “half full”. Turning that anger into collective resistance is both an act of self-defence and the best way I know of “living the moment to the full”: fighting for the future in the present.

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