The Secret Death

[A wall on the Chapel of Bones in Evora, Portugal—yes, those are human bones]

Any death that announces itself in advance is inevitably a more horrible death, at least for the one who dies, than the one that comes of a sudden and discretely removes you, quickly, easily, with no time for the anguish and the preparation for a thing for which one can never, ever be prepared.

For when you find out you have terminal cancer, learn that it is doing its noxious work inside you, you come to know something intolerable. You know that it has already been there for some time, perhaps for years, lurking undetected, evading the screening, causing no pain or discomfort that might alert one to its existence, biding its time, preparing to make itself felt only when the game is so far advanced that a life-changing ordeal is assured, even if somehow death is avoided. Try as you might, in such a situation, you will be unable to avoid that most corrosive of thoughts: “If only I’d…” 

You go to the doctor when you have to urinate too much, or too little, or there’s a little discomfort in that area, and he sticks his finger up there and pushes, and there’s pressure but no pain. Or your chest hurts—actually it’s not pain but pressure or burning—and you have a little bit of a sore throat, and you have been eating cough drops for a few weeks but it won’t go away, and the doctor listens with the stethoscope and checks your heartrate and blood pressure. And in both cases, the doctor assures you that you’re fine.

But he does not know that you’re fine.  This is merely the professional rhetoric of physicians, which most of us are incapable of properly translating.  

You see, they tell you things as matter of fact that they cannot know with certainty. When you try to force them to greater honesty, to give you the odds that there’s nothing seriously amiss given the particular limited knowledge-gathering techniques they employed, they are generally apt to look uncomprehending, as though you had asked them to demonstrate that the earth is not flat. 

Respond to a doctor who has just checked your prostate and told you he is sure you do not have an aggressive cancer that you want to know how he knows that, and he will say something like “Well, because I do this a lot, I’ve seen a lot of patients with your symptoms, and your prostate feels like the prostates of these other men, and none of them have had cancer.” 

Try responding this: “But that is not knowing, and all those previous cases are not a proof. There is still a chance, I could simply be the first.” 

The doctor has probably not read David Hume and would not care to hear his argument concerning the imperfect nature of inductive reasoning in any event.  There is simply an uncomfortable feeling in the air for a moment, then the doctor will ask you if you have any other questions, and you will shake your head. He will tell you to relax and send you out to the desk to make your co-pay.  Then he will move on to the next person in the waiting room. 

And you will go home, still lacking the knowledge that you do not have death growing inside you at that very moment. 

The economy of medical diagnosis is predicated on statistics.  That is, on the calculation of human life as something that can reasonably be thought about as we think about, say, the chance of winning $50 with a lottery ticket. 

The patient explains that he is having stomach pain, a strange burning sensation in his upper abdomen that began four days ago, very occasional initially, only perhaps three or four times in a day, and for seconds at a time, and that now occurs every five or ten minutes, with greater intensity. 

The doctor palpitates here and there, listens to the patient’s breathing, takes a urine sample, checks the vitals that the nurse recorded before the doctor’s appearance. Then quickly (and it must be quickly, for there are other patients who must be gotten to), in his mind’s eye, he thumbs through the memories he has of other cases, of things he has read, of distant recollections from his residency and medical school work, and in a matter of minutes or perhaps even seconds determines that the chances are good that this is a case of some gastro-intestinal tract disturbance of minor character, correctable by time and perhaps a probiotic or an antacid. 

Chances are good. 

This phrase could theoretically always be translated into a statistic, even if the doctor is not immediately able to call the precise number to mind.  Perhaps the research exists somewhere that shows the number to be, let’s say, around 65%.  This means that in nearly 7 of 10 cases, the diagnosis is accurate, and the patient goes off to obtain his probiotic tablets or antacid medication and in a few days isn’t even able to conjure up the memory of what the odd burning felt like. 

But in more than three of 10 cases, the diagnosis is not correct. 

In some percentage of this number, probably the majority, maybe even nearly all of the remaining cases, the actual cause is still minor and benign, and the patient recovers fully, and usually quickly, despite the doctor’s mistaken diagnostic guess. 

In some number of cases, however, a small number and perhaps a very small number but always a number greater than zero, the diagnosis is badly, perhaps horrifically wrong. 

In these situations, the patient has some terrible bacterial infection that, given the extra two days between this visit and the subsequent trip to the emergency room in a squad, is able to effectively cripple his internal organs and bring about his painful death.  Or he has an invasive tumor in his stomach that is rapidly expanding and that will, in due course, inevitably, inexorably, colonize his body to the point that it—his body—simply surrenders to the tumor, cedes to it, and stops functioning, and the delay in the diagnosis turns out to be of some unknown but significant import. 

And in the cruel and stupid danse macabre that is the way of nature, the tumor that forced the body to its death will in turn die without the mouth and the stomach of the body it invaded to bring it nourishment. But in fact, it isn’t even an invader. It is made up of cells of the very body it wants to kill, transformed into little antagonists by the mysterious calculus of random mutation.  It is the body turned monstrously against itself, an auto-destruction, a suicide of a particularly sinister variety in which the body becomes multiple and one part of it murders the rest, and incidentally also puts an end to itself.

Do you want a problem of sufficient difficulty to work on for a lifetime, however long that turns out to be for you? Think on what was in the mind of God when he produced a world that operates according to such a logic.