I am deeply honored to be asked to contribute some thoughts to this book.
In thinking of what I have learned — after fifty-two years of practicing medicine and sixty-one years of personal experience with significant chronic illness — that might be useful to someone newly diagnosed, many things came to mind. There are countless articles and even books about them all. So I am writing about something closer and more personal, something woven into our very fabric that we may never have noticed; something that has made all the difference. Over time it has been called many names, but I would like to call it by one of the oldest: the Will to Live.
I first encountered the Will to Live as a young teen. I was walking up Fifth Avenue on a Saturday morning, window-shopping with my posse of friends, when a flash of green caught my eye. There, growing through the New York sidewalk, were two tiny green blades of grass. Small and tender, they had broken right through the cement to reach the sun. The image is still perfectly clear in my mind. As a New Yorker, I had never witnessed the power of living things before. I had been awed by the miracle of it.
My first personal experience with the Will to Live happened several years later when I was a young physician. In 1981, I developed peritonitis and sepsis when the sutures holding my intestines together gave way a few days after a six-hour abdominal surgery. By the time this was correctly diagnosed, I had become gravely ill. I was rushed back to the operating room where further surgery probably saved my life. I remember being pushed down a corridor at a dead run, the lights overhead flashing by, my surgeon, who was also my friend, running alongside my gurney. Medical culture being what it is, he was talking to me about my case as if we were two physicians lunching together in the doctors’ dining room talking about a mutual patient. “You know,” he said conversationally, “because of the infection, we will have to close by secondary intention.” Filled with drugs and very ill, I remember thinking, “Secondary intention. I used to know what that means.” Then events accelerated, and I lost track of it all.
Hours later, I awoke in the recovery room giddy with the realization that I had survived. Half conscious, I cautiously explored my abdomen with a fingertip. There was the same big soft bandage that had been there after each of my other surgeries. Comforted by the familiar, I drifted off.
The next morning, a nurse appeared to change my dressings. Chatting comfortably with me, she pulled back my bandages, and I looked down expecting to see the usual sixteen-inch incision with its neat row of a hundred or more stitches. Instead, there was a great gaping wound, as open as any I had ever seen while assisting in the operating room. My surgeon’s words came back to me in a rush — secondary intention — but today, I could remember what this meant. In the presence of infection, there could be no sutures. The surgical incision would simply be left open to heal on its own.
Deeply shocked, I looked down at the ruin of my abdomen. I remember thinking, “Surely this is a mortal wound. There is no way this can heal.” My nurse chatted on cheerfully as she replaced my bandages, unaware of my shock. The next morning, she was back to change my dressing again. This time, I turned my face aside and closed my eyes. She spoke to me pleasantly as she tended to my physical needs. I didn’t answer. I was in despair.
For several mornings, we went through this same routine together, she removing my bandages, murmuring encouragement, I, head averted, awaiting the end. After a week or so, it occurred to me that against all probability, I was still here. Perhaps I would not die of this great wound after all, but would have to live with it. This raised a completely different set of concerns and worries. How would I live with this great deep hole in my front? Perhaps, after many years, it might fill in and become flat, a scar sixteen inches long and several inches wide. In the meantime, how would I bathe? Could I wear extra large clothes or fill the deep trench in my belly with cotton so it would not show?
After a few days of such musings, it became obvious that if I were going to live with this, I would need to see it. So that day, when my nurse pulled back my bandages, I forced myself to look, expecting to see the huge gaping wound of ten days before. But it had changed. Astounded, I saw that it had begun closing in at the bottom and was distinctly narrower. And then a remarkable thing began to happen. Day after day, my nurse would pull back my dressing, and I would watch as this great wound, in the slow, patient way of all natural things, gradually became a long thin hairline scar. And I, a physician, was not in control of this. It was humbling. Yet, I certainly had a front row seat. So do you.
So perhaps what is useful to remember is that the tenacity towards life is our birthright. It exists in every one of our cells. The Will to Live is present even in the most elderly and the tiniest of human beings. The power of the life force in those two little green blades of grass is there in us all.
Based on a story in Kitchen Table Wisdom (Riverhead), 1996. Dr. Remen has retold the story for I Am with You: Love Letters to Cancer Patients.
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