Dedicated in jest, but with great love, to my friend who loathes Camus.
This blog contains discussions of / about depression, suicidal ideation, assisted dying (voluntarily euthanasia), end of life and care plans.
The week between and choices
I had a week between the follow-up tests and my follow-up appointment. The follow-up appointment was to discuss the results of the tests.
As I said in the last blog post, I had a lot to think about.
I’m going to start with a little bit of background about myself and what kind of values and opinions I had prior to diagnosis and hold probably more resolutely now.
As I touched on in my blog post The Phone Call; “I made the decision to have the mammogram in the first place and I made the following decision to continue with the investigation.
My body, my choice. My personal sovereignty and agency.
Equally, that might not be the appropriate decision for someone else.”
I would like to think that all decisions are made in full knowledge of the facts available at the time. Facts can change and more information might become available. In which case, those decisions might change or be reviewed. They might appear poor decisions in hindsight, but it’s vital to remember what the situation was when the choice or choices were made.
It’s also important to acknowledge and respect people’s agency and personal sovereignty around their health and wellbeing – even if you disagree.
The Camus Question of Choice
Camus has been significant to me since I first discovered his writing when I was around the age of 13 or 14.
I have experienced depression, and in some cases, suicidal ideation, since around the age of 5. I have been treated for it many times, I use a combination of therapies to manage it, but it has been, and remains, a part of who I am now.
When younger, my strategies weren’t so great, my capacity to emotionally regulate was also not so great, and it was a different time, in a different culture.
Camus was like sunlight beaming down through my clouds and fog, illuminating the cave of my psyche.
Camus quotes about choice
“There is but one truly serious philosophical problem, and that is suicide. Judging whether life is or is not worth living amounts to answering the fundamental question of philosophy. All the rest — whether or not the world has three dimensions, whether the mind has nine or twelve categories — comes afterwards. These are games; one must first answer. And if it is true, as Nietzsche claims, that a philosopher, to deserve our respect, must preach by example, you can appreciate the importance of that reply, for it will precede the definitive act. These are facts the heart can feel; yet they call for careful study before they become clear to the intellect.
I draw from the absurd three consequences, which are my revolt, my freedom, and my passion. By the mere activity of consciousness I transform into a rule of life what was an invitation to death — and I refuse suicide… Obeying the flame is both the easiest and the hardest thing to do. However, it is good for man to judge himself occasionally. He is alone in being able to do so.
But it is bad to stop, hard to be satisfied with a single way of seeing, to go without contradiction, perhaps the most subtle of all spiritual forces. The preceding merely defines a way of thinking. But the point is to live.”
Personal decisions, choices sovereignty, agency.
The choice of treatment
It was not axiomatic that I would pursue treatment if I was diagnosed with breast cancer.
I had to give some consideration to whether I was going to seek treatment if I was diagnosed with breast cancer.
I could choose for this disease, if diagnosed, to be the thing that ended my life. That’s a completely valid option, although confronting to many.
Freedom of choice is the key for me.
I could choose to pursue alternative treatments – although that option was honestly not one I considered deeply. I do value science, statistics, and quantifiable data. However, it was still an option and it is an option that people do choose.
I wanted to understand what options might be laid on the table so that I was better prepared for them. If the results were clear, obviously this preparation process would be for naught. This is, however, part of the way I function best – to kind of run the variables, as it were.
So I had to consider – surgery, chemotherapy, radiotherapy – in the broadest of terms. My question to myself was yes or no at this stage, I couldn’t dive deeper because I didn’t have the information for detail. My considerations at this stage were all broad brush strokes.
I decided, in the end, that much of my decisions would be a baseline of yes to treatment with a consideration of quality of life vs quantity of life.
I remain deeply passionate about a person’s right to choose an assisted, painfree, dignified death. That is the choice I will make if it is possible. Equally, I have no judgement on people who wish to live as long as possible regardless of circumstances.
I do have a problem with people trying to take away my personal choice in this matter.
I also think it is a tragedy when people are placed in the position of having to make those kinds of impossible decisions for someone else, especially when the person they are deciding for has never discussed their wishes.
Have the courageous conversations
So please, people, have the courageous conversations. Think about what you would want in terms of medical care if you couldn’t communicate for yourself. Write an advanced care plan. Think about and communicate your thoughts and wishes around funerals, cremation, burial. Write a will. Sign up to be an organ donor. Seriously, this stuff is important. You never know when your number is up.
The choice around transparency and communication
To my mind, it was not an automatic decision to tell people what was going on for me.
I needed to decide, for myself, if I was going to tell people or if I was going to keep this experience private.
I’m actually a very private and introverted person, but I place great importance upon communication and transparency. I think connection is one of the highest reasons for living.
So in light of those values, I made the choice to talk to a few of my closest friends about the fact that I was waiting for test results that could, potentially, be impactful.
Those conversations proved to be great kind of preliminary strategy meeting. Interacting with people, experiencing the responses I received gave me more to consider.
It seemed to me that we didn’t have particularly good models in terms of how to respond to someone who is sharing that they may be facing a health crisis. I also decided that we don’t have good models for communication generally around a health crisis. This has been my opinion for a long time about grief, but it was becoming very clear to me that this was also the case with this kind of experience as well.
I further decided that if I was diagnosed with breast cancer, I would want to put in place some guidelines to protect myself from things that people do or say that are not helpful and can, in fact, harm.
Strategies were definitely needed for me to navigate this with grace.