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A Piece of My Mind
January 16, 2002

The Body Politic

Author Affiliations

A Piece of My Mind Section Editor: Roxanne K. Young, Associate Editor.

JAMA. 2002;287(3):286. doi:10.1001/jama.287.3.286

I will always remember the day I heard the news. I was at home when the telephone rang. At first, I felt as though I was having an out-of-body experience, looking at myself from above, hearing the voice of the caller echoed from a distant planet, telling me everything had changed. It was a surreal moment of shock and disorientation. As the caller spoke, my eyes became fixated for a while on the photograph, on my desk, of my two daughters who had just turned 1 and 3. Their joyful, silly, beautiful expressions were suddenly so painful to look at. What would happen to them? I noticed my long "to-do list" for that day, my full calendar. I have been a slave, I thought. Most of the life I have "scheduled" for myself seemed so inconsequential. In the midst of my panic, I felt a surprising relief and freedom, at not "having" to do anything anymore, at least for a while. Strange way to take a break.

There are certain potent experiences in life that become prisms through which our past and future are filtered and redefined, turning points according to which our lives are permanently rearranged in a before-and-after era. In these moments, we feel the "loss of innocence" because we experience the fragility and impermanence of life. This was such a moment for me: the day I was diagnosed with cancer at age 35.

Then came the terrorist attacks of September 11. For many, the attacks seem to have evoked the identical feelings that I felt upon diagnosis. It is as if we, as a nation, were diagnosed with cancer on September 11. From diagnosis, to treatment, to living with the fear of recurrence, this new terror feels surprisingly familiar to me and I find myself strangely prepared to cope with it.

One of the most disturbing aspects of our current predicament is that the terrorists live among us. While it is true that they are from other countries, initially "outsiders," they have managed to become part of us: they have adapted to our system, used it to nurture and educate themselves, and then turned it against us. It is hard to know who they are and where they live, because they have become part of "our body." It is the same insidious, ruthless quality that adds to the terror of cancer. The body attacks itself and the disease feeds on the body while killing it. As in the case of the suicide terrorists, the cancer kills itself in the process of killing the victim.

What follows the diagnosis is the treatment: in our case, military, economic, and other ways in which we think we can control the spread of the enemy. But just as in cancer, there is no magic bullet. I remember being presented with different treatment options and being asked to choose one, each with an uncertain outcome and unique set of risks. It was confusing and terrifying to be asked to make the most important medical decision of my life, for which I had received no training. So it seems now with our war on terrorism. We are in uncharted territory, fighting the war in every conceivable way, all the while painfully aware of our vulnerability and lack of certainty on the ultimate outcome of our course of actions. This period of "treatment" is slow and difficult. We have to adjust to many new "side effects," such as the loss of some of our freedoms, while at the same time staying on course and moving on with our lives.

At the end of the military "treatment," after we have done all we can to fight this enemy, as if all the suffering we have endured were not enough, we must now live with the fact that this is a chronic disease, a permanent fight. In the case of my cancer, there is no test to prove that there is not one cancerous cell floating around somewhere in the body, waiting for its moment to attack again. The analogy between the terrorists' "sleeper cells" and dormant cancer cells is all too perfect. We are already experiencing the "fear of recurrence" with the terrorists even before the "treatment" is over. The next attack could happen anytime, anywhere, without warning. This is the invisible, stalking, continuously lurking fear of cancer—and so it seems with terrorism.

On the surface it seems like an unsettling loss of control and stability. But the hidden gift lies in the fact that it is actually the loss of the illusion of control over how and when we will die. We can stockpile all the Cipro, lock ourselves up in our basement, and still die in our sleep. There may be a cure for cancer or terrorism, but there is no cure for death. Lance Armstrong says that what he learned from his battle with cancer is that he could die. This is not necessarily grim news. From every trial comes opportunity. Our opportunity is to face our fear of death and to choose to live a more free and rich life. Many people have reconsidered their values and priorities since September 11. The slate gets cleared, and we put back what is consequential: family, friendship, enjoying work, taking time off for oneself, helping others.

Achieving a sense of peace in living with terror is the ultimate challenge. The emotional landscape of any cancer patient, and now that of our nation, is forever altered. In realizing that we never had any control to begin with, our illusion of control is gone. We are disillusioned! It is this delicious freedom that begins to bring a sense of peace.