I was home once again, and my greatest wish had been realized. Somehow I thought my life would now be simplified, and that I could wield complete control over the ways in which I desired to spend my time and conduct my remaining life.

With something akin to fascination, I looked at myself in the mirror and focused my eyes on my protruding stomach region which would one day be the cause of my death. The subjects of death and other intense, wrenching emotions possessed a magnetism which had always held me spellbound. I was drawn to the startling views of human tragedy in both literature and art forms; a life tottering precariously on the edge of sanity or mortality could offer a glimpse of the more painful aspects of reality which many often neglect to acknowledge. Images which accurately depicted the horror of war or the anguish of a mother of a stricken child were those which captured my attention; though beautiful works would please my eye, only the gripping views of life held the capacity to stir my senses.

The thought that I now shared a common bond with those gripping views of existence similarly held my fascination. I wondered what my family would undergo during the harsh period following my death; I pondered whether I would see earthly lives when I no longer was part of the world. I spent lovely afternoons in peaceful reflection, drinking in the earth's beauty to somehow retain the days as if they were my last.

Time itself lost its importance as I embraced the cycles of nature and my own life as one, rather than separate ent.i.ties. I marveled at the pitiable lack of control we, as humans, have over our lives; after attempting to rule the world, we are at last brought to the level of all things through the element of mortality. I shared a kinship with autumn following the rediscovery of cancer. Like a tree divested of its leaves, its only proof that life yet flourished deep within; I questioned when my color, too, would fade, rendering me helpless against winter's icy grasp (death). Death was no romantic notion which smuggled lives on moonlit nights; it was merely an endless cycle.

Nov. 1981... I quieted my thoughts and listened as a distinctly familiar echo of sadness resounded in the autumn air. It seemed as if the old tree above me was attempting a futile last stand in the face of the impending desolation of winter. A blast of northerly winds scattered the furiously spinning leaves to form a semi-circle about my feet.

I picked up the leaf, noting its fragility as it crumbled under my touch. I realized that I was observing a change of seasons in which only brittle remnants of spring remained to display that life had actually existed. A gust sent the fragmented leaf to be buried unceremoniously in the midst of thousands of other leaves, which were rustling their distaste for their hapless plight.

I watched several more leaves rattle a loud protest as the wind determined their fate. Another leaf, one which could easily be labeled as a spectacular tribute to nature itself, was swaying gently in the crisp breeze. It was different from the other leaves, seemingly unafraid of its destiny. I continued to watch until it was slowly delivered to the ground to rest in silence at my feet.

That is the way death was intended to be, I thought; stealing quickly over its prepared and quietly waiting subject, death overcomes life with no struggle and no outcry. I sighed and wondered when I, too, would be beneath the dried and decaying vestiges of many summers pa.s.sed.

I culminated my restful sojourn amongst the colorful show of leaves with thoughts that have frequently entered my consciousness during reflective intervals; one must first accept death if he is ever to understand life.

I will never forget an incident which occurred shortly after my release from the hospital. Seated in the middle of the shopping mall, I was engaged in observing people hurry in and out of stores, and while my face did not radiate feelings of great joy and elation, I did not wear a mask of sorrow either. Just then, a man happened by and remarked, "smile, you're not going to die!" I remember how idiotic that phrase sounded to me, and it left me speechless. "Yes," I thought, "I shall die. . . and sooner than you might suspect." Everyone dies.

Quite apart from denying my illness, I found myself quite preoccupied with it, and initially it was difficult to carry on in a "normal"

fashion in the sense that I could not detach my mind from the fact that I had cancer again. After learning of my recurrence I immediately began thinking thoughts such as, "if I subscribe to this magazine, I wonder whether I'll receive all of the copies. . . ," and while driving down the road, "I wonder if I'll ever get a speeding ticket,"

or when in a pet shop, "if I got a parrot, it would outlive me."

I remembered my china dishes and realized that my dad had been right; I should never have purchased something which represented the future.

The future did not belong to me. . . it was dissolving before my eyes.

My dreams were changing out of necessity, since most dreams depended on time for their fulfillment... and time was one amenity that I could not hope to claim.

Nov. 1981... I dismissed modeling altogether after appearing in a luncheon (style show), which I enjoyed entirely. I somehow felt unable to accept the demands of the career when I felt my health situation was so uncertain and unreliable. Admittedly, I could have modeled for a short time. Somehow, though, it didn't seem important any more. I was tired...

I thought of the teenager who had a car, yet lacked the fuel to drive it.

I speculated as to whether or not I would witness the spring-time again, and could not help but question absently if my 20th birthday would prove to be my last. I was unable to release myself from the thought of my impending death; I wasn't simply Lauren Isaacson. I was "Lauren Isaacson, victim of cancer." I identified myself with the disease and found my thoughts encompa.s.sing various subjects with cancer continually in the back of my mind. I never denied the presence of the disease, nor did I wish it on someone else, and perhaps this is what allowed me to bridge a period of gray disillusionment so common in the acceptance of solemn news; I would much rather face a heart-rending truth than to live amid a cloud of fantasy derived of the mind. Tumors have no conscience, and no amount of wishing, cursing, or bribery will cause the disease to disappear. These mind-games will one day come to an abrupt, emotionally wrenching halt or lead to personality disturbances if not corrected; such reactions only injure the individual or those with whom he must a.s.sociate.

In coping with a weighty truth of such magnitude, the family as well as the patient, will experience various and ever-changing emotions, and I believe it is quite important that these feelings are ventilated.

Simply because the family is not afflicted with the illness does not mean that the individuals are immune to its emotional nuances. In fact, the family is sometimes the worse off; they essentially feel helpless, unable to ease physical pain or shield their loved one from his frightful pursuer.

When the family is able to openly converse on the topic of the patient's illness and imminent death, the entire affair seems less formidable, rather like a beam which is directed upon the unlit recesses of a room, thereby dispelling the uncertainties which lay dormant in the darkness. Because there are manifold reactions to adversity, related conversation will evolve at varying rates. While some people would be ready to speak candidly after a brief time, others need to ingest the situation gradually and should not be pressed into heavy conversation directly following a shock. Moreover, there exists in most humans the great need to face life's circ.u.mstances with dignity and composure and would not, therefore, relish a serious discussion until they could do so without losing control of their emotions and causing a tearful scene.

Although it is unhealthy to continually dwell on the plight of the family, silence is debilitating. . . especially if it evolves through avoidance of the problem, rather than simply the inability to verbalize one's thoughts. True coping deals with self-expression, not the clever avoidance thereof. One should never attempt to stifle grief, for to do so will create unendurable stress; and what, I might add, is so terrible about venting one's sorrow in the form of tears, when the situation certainly merits that behavior?

Anger is an understandable reaction to the discovery that one harbors a debilitating disease, for since everyone must eventually die, surely there are more pleasant routes toward that destination if given the right to choose. Moreover, anger is thought to be a less degrading form of expressing depression. No one wants to suffer or restrict himself in a manner unnatural to his lifestyle, nor lose his sense of control, no matter how much or little he actually has.

If anger is a prevalent emotion, its release is necessary; yet projecting that anger on undeserving family members or hospital personnel is unfair. Anger is counter-productive when wrongly displaced; fanatical rage and irate demands are increasingly ignored and replaced by the unfortunate avoidance of the enraged individual.

No one can benefit from this chain reaction.

An alternative which could be used by the patient having the objectivity to discover his outward rage is anger expressed through writing or intelligent conversations rather than transforming the anger into unfounded complaints. The problem is not the unsmiling intern, or the wife who arrived ten minutes later than planned. The problem is health, and if not dealt with, att.i.tude as well.

A reasonable exception is when the patient's anger is derived of pain; it is virtually impossible to be civil if each breath heralds another moment of severe physical anguish. This belligerence should not be taken personally by either relatives or hospital staff, nor should the unfounded anger described above be ingested as relating to their presence or prescribed duties.

If it is attention the patient needs, it is more likely to be given if he behaves in a manner deserving of amenity. It is a pleasure to be near a person who, despite his personal problems, can retain humor and conduct himself in a respectable manner. If my experience is any indication of the quality of the residency in hospitals, I found the staff to be most personable if treated likewise. On the rare occasion that a patient is forced to abide a hostile nurse, or one who refuses to believe that he is suffering to the degree that he claims, a complaint is well within reason. One case in particular concerned an incontinent elderly woman who, after an accident over which she had no control, was chastised by a hostile nurse, resulting in tears which should never have been provoked. A patient is not paying for abuse; moreover, a hospital without patients is just a stone building, and its personnel is up for hire. Inflicting emotional anguish has no place in the medical profession.

When I felt frustrated by the constraints which resulted from my cancer, I encountered no pervasive or continual anger. Furthermore, the anger was targeted at the source of my inability to function properly, rather than projecting it toward an innocent companion. Mine was the self-contained anger similar to that which I would feel after entertaining influenza for nearly a week; weary of its limiting effect on my mobility and general well-being, I would hurl devastating thoughts inward, then later proceed to calm my cantankerous spirit and await the arrival of health.

My father held a rather negative view of the possibility that good could prevail over evil; he always expected the worst, and often was quite right in his a.s.sumptions. Even so, expectation does not cancel one's disappointment at having supposed correctly, and his broken heart was obvious. A touching moment in a movie, a poignant verse of song or the reading of one of my poems was enough to send a tremor through his voice in a later attempt to speak. Often depressed or angry, he was tormented by the many adversities which had befallen our family. It just didn't seem quite right that he should have such difficult burdens after he had lived a morally conscious life; others, lacking all sense of moral responsibility, seemed to live long and healthy lives, or died simply because of their own ignorance and gluttonous indulgences.

Hounded by such sources of resentment, acceptance was gained, then lost once again at varying intervals when he viewed the healthy, but empty lives whose health, he thought, should have been my own.

Aside from the family, my dad had no confidant or close friend. He, like many members of the family, was quite self-sufficient.

Unfortunately, one's self-sufficiency, displayed in grave situations, can discourage closeness, whether consciously or not. Thus, when such an individual truly desires someone to hear his concerns, no one is near enough to care. Even persons with whom one had worked on a daily basis can prove to be unenthused listeners; often their a.s.sociation clearly ends within the confines of the job description.

Though not always apparent, my dad was a highly sensitive individual.

An injustice or injury persisted, inflicting pain and stress. More than anything I believe my father needed unsolicited affection and demonstrations of sympathy; lacking these, especially from his co-workers, Dad felt himself betrayed by the one group with whom he had spent so much of his time. He could easily have drowned in self-pity, for no one wished to help with the bailing out of his broken heart; sorrow was like a hat which only he could wear.

My father would, on occasion, mention that if he had not married, or had children, he would not have had to experience the pain of losing dear children or seeing them riddled with health disorders. Life without emotional grief would be "easier" and more stable, yet to shelter ones self from close relationships would also be an enormous deprivation; love is the foremost joy of living, and it cannot grow through alienation from society. Even the smallest pleasures seem more meaningful when they are shared, while the tragic moments are buffered by love. To separate ones self from affection for others denies a virtuous human potential to develop, as it simultaneously creates more emptiness than that which occurs upon the death of a loved one; the grief-stricken survivor has memories, but the emotional hermit has only stability. There was indeed, a sacrifice for love. It was one that my dad was willing to take.

In one of our conversations, I once asked my father if he thought he had basically accepted my health disorder. He replied, "I don"t think I will ever accept it, because it's not acceptable." For his part, maybe he just lives with it. What other choice does one have, excluding madness or suicide, but to live with it? (It just doesn't mean that he has to like it!)

Guilt very often accompanies the illness or death of a loved one, and can be released through conversation. The unfounded sort, stemming from regrets such as a patient's unfulfilled dream which the relative felt he impeded, or a mother's inability to detect subtle changes in her child's health, is a counterproductive, if not debilitating, manner of reacting to the problem. These emotions are quite corrosive to the individual, and it is important that they are quickly corrected; this can be done through attentive listening and positive reinforcement.

After discovering the malignancy in my stomach, my mother effectively chastised herself by a.s.serting that she "should have noticed that I was eating less and getting thinner." She held on to her belief while I tried to a.s.sure her that the extent to which the cancer had spread was not her fault. I reminded her that many children are rather lanky and thin when they are growing too rapidly for any food which they eat to transform into fat; the body needs the nourishment to sustain itself, and has no excess for insulating purposes. With time and rea.s.surance, she finally dismissed her guilt; I listened to her statements, returning not with, "You shouldn't feel that way," but with reasons which effectively reinforced the pointlessness of her guilt. As with any invitation to change one's outlook, a person fostering guilt must be shown why his view is unreasonable and needs to be altered.

Statements such as "Don't feel guilty" define the desired destination, but offer no direction as to the means of attaining that goal. I have sometimes wondered whether this type of guilt is not merely a subconscious means of inflicting punishment upon ones self in order to more deeply share the pain felt by the ill person. Guilt which is evoked through hateful thoughts or malicious wishes toward the ill person is sometimes more difficult to manage, due to the fervor with which the mental darts were hurled at the patient before the onset of illness. Abreast a wave of superst.i.tion, the guilty party quietly blames himself, feeling responsible for the evil which befell his victim. It is important for the guilt-stricken individual to realize he does not control the hands of fate. To further complicate matters, often the dying or deceased individual is surrounded by an aura of purity, and it is deemed unfit to denounce his character despite the validity of the statements. Though loss makes memories all the more dear to the heart, I feel that one should not forget that these people, sick though they are, are human; they possess irksome habits and have made foolish mistakes as does all humanity. To elevate an individual beyond his former limitations is an open invitation toward the housing of personal guilt, since any negative emotions concerning the patient will be thought of as hostile and unfounded; one is not only denying the disturbing propensities of the patient, but also, and more important, he is denying his true feelings, thereby trapping himself.

In this scope, I might add that elevating a person who has not yet died can create an undesirable situation for him, in that he may feel threatened by this new and unrealistic public opinion of himself which, consequently, is greater than he is able to uphold.

Another sort of guilt, planted by the patient, is somewhat related to the above. Although conversation is generally thought to be a healthy exchange between concerned individuals, there are those who, unfortunately, take the business of sharing their health problem wholeheartedly. Applying no restrictions on themselves, they continually voice their complaints until a situation is created wherein the complaints are more of a burden to the family than is the illness.

I feel that reactions such as these on the part of the afflicted are unfair and completely selfish. Forcing constant awareness of an illness upon a loved one is cruel and emotionally debilitating.

When a situation such as the one described occurs, I wonder whether the patient truly loves his "subjects"; a caring individual would still want his family to derive joy from living despite his inability to actively take part. Jealousy has no place in love, especially when a loving relationship is placed in jeopardy by the imminence of death.

A patient's jealousy can often promote guilt; ultimately, however, it begets only resentment, not true love and devotion.

My father was acquainted with a man whose wife was a constant source of worry. She was what I would call "the delicate type," in need of constant attention and sympathy whether she truly needed it or not.

The day finally came when she found herself bedridden, demonstrating the symptoms of an actual health disorder, and her personality took on the shrieking demeanor of an angry bird. She expected constant nurturing care from her husband, yet nothing he did would please her.

After hounding him relentlessly to pick up an item at the store, she would be enraged because of his "lengthy" absence.

Eventually the poor man agreed to place his wife in a rest home in her home town. However, through her injection of guilt, he still felt obliged to maintain a daily vigil by her side. The man became emotionally and physically exhausted, and suffered to such an extent that his sanity was nearly obliterated; in tearful, emotional outbursts he would relate the "sad" condition of his wife, and elaborate in detail their conversations and prayers, never thinking that her's was a very disturbed mind. Bereft of any other communicational outlet or friendships, he accepted the blame for his wife's unhappiness. In effect, he was starving for conversation and emotional support, causing an irrational view of reality.

Although, toward the last portion of her life, the wife was mentally incompetent concerning her nasty behavior, she would have been capable of changing her actions earlier in life, yet, through a jealous and self-centered need, she obtained a constant awareness of her presence by lamenting any flaw in her well being. The husband may have enjoyed the initial pampering as a means of elevating his feeling of self-worth; here was a woman who needed him. However, as any excess can be overwhelming, her preoccupation for comfort was his final undoing. Had she thought less of herself and allowed him the freedom to breathe, the obsessive guilt she strove to plant would never have taken root in his mind.

It is essential that the patient allows his family to continue in a "normal" fashion, for it must be accepted that there will be a time when life must carry on without the sick individual. This is not to say that a husband should start to seek another mate before his wife meets her demise; behavior of this nature is cruel and, I believe, says that his wife was not loved but only needed for the beneficial comforts she could provide. However, continuing attendance in a church, or meeting with friends should in no way be thought of as frivolous or forgetful of the sick, but rather as a form of therapy for the living.

I wanted my family to continue its current lifestyle, and for the most part, that was no problem. However, Mom continued to feel guilty about her health and ability to do anything she desired while her young daughter was forced to stay home.

As my cancer progressed and I did less in the social realm, spending week-end nights at home, my mother became concerned about leaving me alone when they went on a small excursion or nighttime gatherings; she worried that I might be lonesome or scared, or need help of some kind.

It was somewhat of a ch.o.r.e to a.s.sure her that I would be fine; should I be scared or lonesome, it would pa.s.s, and with regard to my health, she would be powerless to aid in my comfort even if she was at home. As a final effort I confessed that I truly enjoyed being alone sometimes.