Lately I have been slowly but steadily reading a book entitled Machine of Death. It is a collection of stories inspired by this episode of Ryan North's Dinosaur Comics, which is one of my favorite things the Internet, and even the world, has to offer. Basically, each of the stories takes place in a different alternate universe with one thing in common: there is a machine that, with a simple blood test, can tell you how you are going to die. The machine is always correct, but it's also frustratingly vague; "PEANUTS" can mean you will die of a peanut allergy, or are sideswiped by a peanut truck, or are crushed to death by Charlie Brown's balloon at the Macy's Thanksgiving Day Parade. And it certainly doesn't tell you when. Most of the stories are dystopian; a world in which everyone can know some of the facts about how they will die, with no means of avoiding it and no known means of delaying it is a world with some serious problems to deal with. I am loving this book, carrying it with me wherever I go. It is thoughtful, diverse, and generally well-put-together, but I realized today exactly why the stories appeal to me: I am living in a world with an actual Machine of Death. Well, sort of.
In May of 2008, my mother was diagnosed with stage two ovarian cancer after reporting some abdominal pains to her doctor. I avoided searching about ovarian cancer on the Internet, but eventually I did and the news was not comforting. Still, she had her surgery, her chemotherapy, and things seemed to be going really well, until it came back. She had another surgery, and is in the midst of more chemo, and again things seem to be going well. All things considered and relatively speaking, she is doing okay. Her last chemo session of this cycle will be on Tuesday, and then she will get a three month break before another scan, which will hopefully be clean. Nonetheless, I can't help feeling like she already got her Machine of Death printout: OVARIAN CANCER.
It seems inevitable. Sooner or later, this thing is going to win. The doctors don't talk about "cures," they talk about "management," "treating the cancer like a chronic disease." I'm left wondering, when? At what point does the management become worse than the disease? If the prediction will inevitably be correct, then is there even a point in trying to thwart it, or delay it? And if so, then is there a graph of utility of delay versus pain caused and when does it cross from one to the other? As I said earlier, it's frustratingly vague, clouded with uncertainty and anxiety. This is what permeates the universes of Machine of Death, and it's also permeating me.
I have always been morbidly curious and obsessed with black humor. When I was little, my dad's oldest friend dubbed me Dr. Death, and I once made a greeting card for my older brother that had clip art of a tombstone on it and said, "Congratulations on being one year closer to death." It's just how my brain works, and I have often had trouble understanding why everyone isn't that way. To some extent we already live in a world that is tinged with the problems inherent in Machine of Death. We are obsessed with knowing what things are likely to kill us, how best to avoid them, who's responsible, &c. I can't count the number of times I've heard about how obesity has now passed cancer as the largest killer of Americans, and what we must do to combat the epidemic. There is a battle-like approach to death in our culture: only one of us will survive. But this is not a battle on an even playing field. Death will always win. It's just a matter of when and how.
On August 2nd, Atul Gawande wrote a wonderful piece for the New Yorker entitled "Letting Go: What should medicine do when it can't save your life?" He looks at palliative and hospice care to discuss one the trickiest questions medicine has to offer. Get ready for a long quote.
"For all but our most recent history, dying was typically a brief process. Whether the cause was childhood infection, difficult childbirth, heart attack, or pneumonia, the interval between recognizing that you had a life-threatening ailment and death was often just a matter of days or weeks… As the end-of-life researcher Joanne Lynn has observed, people usually experienced life-threatening illness the way they experienced bad weather—as something that struck with little warning—and you either got through it or you didn’t…
"These days, swift catastrophic illness is the exception; for most people, death comes only after long medical struggle with an incurable condition—advanced cancer, progressive organ failure (usually the heart, kidney, or liver), or the multiple debilities of very old age. In all such cases, death is certain, but the timing isn’t. So everyone struggles with this uncertainty—with how, and when, to accept that the battle is lost. As for last words, they hardly seem to exist anymore. Technology sustains our organs until we are well past the point of awareness and coherence. Besides, how do you attend to the thoughts and concerns of the dying when medicine has made it almost impossible to be sure who the dying even are? Is someone with terminal cancer, dementia, incurable congestive heart failure dying, exactly?"
Modern medicine has provided us life with an even more vague and obtuse Machine of Death. And the response to attempts to actually wrestle with these consequences is to label them as "death panels" and put everything in a shroud of fear and denial. Ultimately, death comes for us all, whether there is a discussion about it or not, but the discussion can provide greater control over the ending.
Just because I think about death more than others doesn't mean I am any less affected by it. I know that part of me wants to scrap modern medicine and go back to an age when life-threatening illness kills you or it doesn't, but I also want my mom to live. And in the meantime, I am filled with anxiety about the chaos and uncontrollable nature of death. Sometimes I smoke cigarettes and I know that part of the pleasure they provide me is the notion that I am controlling my destiny, even if I am hastening it.
As I said, I have always had a morbid fascination as far back as I can remember, and the one thing that soothes the inherent anxiety and fear is to read and write stories and gain pleasure from the ones I love. So it is that I will read Machine of Death and share it with my loved ones. Huddled together, we can laugh at death and cry later.
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