Archives for category: Cancer

I recently travelled to Brighton to see this exhibition, a collaborative project led by Sussex NHS Community Trust http://onca.org.uk/currentexhibition/

A Cancer Landscape presents works by the artist Michele Angelo Petrone, who died as a result of Hodgkin’s disease in 2007, as well as those by others personally affected by cancer that had been created during a series of workshops at ONCA in 2014. Images from the Wellcome Medical Photographic Library are also on display.

Petrone’s paintings are “images of the emotions and feelings experienced during the cancer journey”. The companion book, The Emotional Cancer Journey, includes the images on display as well as accompanying reflections and quotes from the artist. Petrone’s lymphoma diagnosis was made in 1994. Many years of intensive treatment and relapses ensued until his death 13 years later. The book, completed in 2003 when a relapse had just been confirmed, is an expression of Petrone’s experience of living with cancer:

“I have to tell you all about my journey of illness.”

“Illness and death may be familiar to you, But what is it really like when its your own illness? What is it really like when your life feels as if it’s being taken from you?”

The journey to where?

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“I don’t know where my life will take me”

Two intersecting elements dominate Petrone’s journey: the medical component and Petrone’s emotional response to his illness. His distinctive art movingly encapsulates this intertwining, for example the piece titled The pain of it all, which does indeed visually say it all:

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Sorrow, loss, love, life’s fragility are amongst the themes covered by Petrone. The alienation that accompanies serious illness, when those affected are isolated from diagnosis in the kingdom of the ill, is dealt with in Life goes on:

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“Having treatment, my life is fossilised. Everyone else’s life progresses, goes forward. I just watch as life goes on for everybody except me.”

The other works on display, also inspired by the experience of cancer, are equally moving and haunting.

Much lingers to consider and to reflect on in the aftermath of visiting this exhibition.

CQ

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The first instalment of Jenny Diski’s reflections on her recent cancer diagnosis has appeared in The London Review of Books (http://www.lrb.co.uk/v36/n17/jenny-diski/a-diagnosis).

It is essential reading.

I have always loved Diski’s writing (Skating to Antartica particularly). I read the current article – ‘A Diagnosis’ – with sadness, but also with joy. It is vitally Diski – funny, brave and real – and I am grateful that when faced with the challenge of dealing with her recent cancer diagnosis, she decided to share her experience.

She asks the question:

‘A fucking cancer diary? Another fucking cancer diary… Can there possibly be anything new to add?’

Yes. Diaries afford the possibility of witnessing the experiences of others, and although experiences may overlap and share some similarities, each individual one is unique and invaluable as a direct result of its very subjectivity. Thus, each personal experience is by definition original and irreproducible. The value of reporting such experiences is that, although we cannot truly share them, as invited readers we can listen, witness and hopefully affirm the living of another. Michael Palin speaks of diaries as the antidote of hindsight. Which they are, and as the nearest expression we can get to the possibility of understanding what it might be to exist in someone else’s shoes, they can be the most invaluable and authentic of literary forms.

Especially from Jenny Diski’s pen.

‘The future flashed before my eyes in all its pre-ordained banality. Embarrassment, at first, to the exclusion of all other feelings. But embarrassment curled at the edges with a weariness, the sort that comes over you when you are set on a track by something outside your control, and which, although it is not your experience, is so known in all its cultural forms that you could unscrew the cap of the pen in your hand and jot down in the notebook on your lap every single thing that will happen and everything that will be felt for the foreseeable future.’

The ‘Onc Doc’ slipped in at the outset that the goal was ‘to treat, not to cure’. It is salutary to consider both what is often said and what is mostly unspoken during this most critical of person-to-person interactions. Raymond Carver’s poem on the same topic of cancer diagnosis comes to mind:

What The Doctor Said

He said it doesn’t look good
he said it looks bad in fact real bad
he said I counted thirty-two of them on one lung before
I quit counting them…

… and he said something else
I didn’t catch and not knowing what else to do
and not  wanting him to have to repeat it
and me to have to fully digest it
I just looked at him
for a minute and he looked back it was then
I jumped up and shook hands with this man who’d just given me
something no one else on earth had ever given me
I may have even thanked him habit being so strong

 

Diski also reflects on the doctor/patient relationship:

‘It’s quite hard to rapidly absorb the notion that someone forecasting your fairly imminent death might not be your enemy.’

‘Sullen rudeness is a possible option handed to us cancerees.’

She considers the language used. When given a prognosis of ‘two-to-three-years’, what is actually being said? Is ‘Onc Doc’ favouring 2, or 3, with the extra year tagged on as a hopeful gesture? What does this timeframe meaningfully equate to in terms of how we normally live our lives:

‘Will the battery on the TV remote run out first?’

Suddenly thrown into another sphere, that of the ‘Cancer World’, Diski contemplates the role she may now be forced to play:

‘I am and have always been embarrassed by all social rituals that require me to participate in a predetermined script’.

‘Now I was faced with the prospect of a rather lengthy (in one view) public/private performance by which to be excruciated.’

She rejects metaphors of attack, and refuses to personify the cancer cells in her body:

‘Under no circumstances is anyone to say that I lost a battle with cancer. Or that I bore it bravely. I am not fighting, losing, winning or bearing.’

In the face of her diagnosis and all its inherent challenges, Diski answers her own question ‘why another cancer diary’. She is a writer. It is what she does.

‘So I’ve got cancer. I’m writing.’

 

CQ

 

The Spanish-Argentinian writer’s most recent novel has three narrators, 10 year old Lito, his mother Elena and his father Mario. Mario is dying, and the three contemporaneous voices tell the story of this experience from their own personal perspectives, the stories sometimes running in parallel, sometimes tangential. This is a wonderful book, which somehow manages to capture in just 160 or so pages the individuality and the heterogeneity of our approaches to life, heightened here in the face of dying and death.

We are first introduced to Lito as he embarks on a road trip with his dad. Mario wanted to do this trip with his son, at least once, just like his own father had once done with him. Mario is clearly already very ill, and just about manages to complete the journey. There are no deep and meaningful father-son chats during the trip. The opposite in fact, as Mario has deliberately chosen not to tell Lito that he is dying, or even that he is seriously ill. Later, when Mario has been admitted to hospital for the last time, Lito is sent to his grandparents. From here, Mario, at this point very near death, questions whether keeping his son in the dark has been the right thing to do:

‘you’re at your grandparents’ and you don’t know why, we’ve sent you there until the end of the holidays, I’m meant to be travelling, we talk every day, I try to sound cheerful, am I deceiving you, son?, yes, I’m deceiving you, am I doing the right thing?, I’ve no idea, so let’s assume I am, I prefer you not to see me like this…’

Instinctively, one feels that the lies were a mistake, but it perhaps easy for someone outside the tragedy within which the family find themselves to make a cold-blooded judgement call. Lies beget more lies, which become increasingly complex and entangled the longer they are allowed to continue. After his father’s death, which Lito has been told was the result of a road traffic accident, Elena reports:

‘He asks me how such a big truck could get crushed. I tell him sometimes big things break more. He asks me why Pedro [his father’s truck] looks the same as before, if he had such a big accident. I tell him his uncle did a really good job fixing him up in the workshop.’

Mostly, Lito’s voice is simply that of a 10 year old child, caught in the reality of his own day to day life, which is, at least until the moment of his father’s death, uncomplicated by anxieties for the future, and still in possession of a naivety that allows life to continue unquestioned despite the fact that the worlds of those around him are collapsing.

In Mario’s chapters, he speaks directly to his son, as if writing letters to be read posthumously. Yet, despite this direct address, Mario already seems detached, not quite present. Perhaps the lack of punctuation in his chapters contribute to this, with the text flowing as a stream of consciousness away from him, as his strength and life progressively ebb from reach. Much of what he touches on seems too painful to stay with. Speaking of the lie that hangs around the story he and Elena have concocted for Lito about his illness:

‘…I’d give anything to know what’s going to happen to this lie, what you’ll think of me when you discover it, you’ll have a few photos of me…but I have no way of seeing you, I mean will you be a nice guy or a rogue…’

Reflections on suffering and the aftermath of being given his prognosis are particularly moving:

‘…the worst of it is that I’ve learnt nothing from all of this, what I feel is bitterness, before…I though suffering was of some use…a bit of suffering in exchange for a conclusion…crap, it’s all crap…’

‘…from the moment they diagnose you, the world immediately splits in two, the camp of the living and the camp of those who are soon going to die, everyone starts treating you like you’re no longer a member of their club, you belong to the other club now, as soon as I realized this I didn’t want to say anything to anyone, I didn’t want pity…’

‘…I don’t want to touch anything that’s part of my body, everything in my body is my enemy now, this is what it is to be dead.’

For me, the most captivating voice was that of Elena. She raises many issues around the witnessing of dying, and the complexity of emotions, which can be contradictory and inconsistent, that can accompany this experience. Elena’s chapters are a rich source of references to authors who has written around the subject, as she questions what is happening to Mario and to all their lives in the face of his dying.

Quoting John Banville, Elena speaks of the effect of Mario’s diagnosis:

“It was as if a secret had been imparted to us dirty, so nasty, that we could hardly bear to remain in another’s company yet were unable to break free”

“From that day forward all would be dissembling. There would be no other way to live with death”

Elena also speaks of the divisiveness of serious illness, how it has distanced herself from Mario, at times even alienating each from the other:

‘It drives me crazy when Mario assumes that controlling attitude of his. As though illness depended on our level of composure. Mario is brave, his brothers keep repeated like parrots. If he were as brave as all that, he would weep with me each time we speak.’

‘When I go into the room, dressed in clothes he likes, my hair styled for him, I can sense resentment in his eyes. As though my liveliness offended him.’

So much of the loss around death and dying can happen before physical death itself:

‘By avoiding the subject of his death, Mario delegates it to me, he kills me a little.’

‘By caring for our sick person, we are protecting their present. A present in the name of the past. What am I protecting of myself? This is where the future comes in…For Mario it is inconceivable. He can’t even speculate about it. The future: not its prediction but the simple possibility of it. In other words, its true liberty. That is what the illness kills off before killing off the sick.’

‘For us carers, the future widens like an all-engulfing crater. In the centre is already someone missing. Illness as a meteorite.’

Inevitably, the aftermath rests with Elena:

‘If death interrupts all dialogues, it is only natural to write posthumous letters. Letters to the one who isn’t there. Because he isn’t. So that he is. Maybe that is what all writing is.’

As Elena looks at photos of Mario when he was well, she questions the truth of what we remember:

‘Looking at you again when you were beautiful, I wonder whether I am celebrating or denying you. Whether I am recalling you as you actually were or forgetting you when you were sick. Reflecting about it today…the biggest injustice about your illness was the feeling that this man was no longer you, that you were gone. But you weren’t: he, this, was my man. Your worn-out body. The last of you.’

A gem of a book, which haunts and lingers…

 

CQ

 

”She has a lump on her – her breast, like a gull’s egg.”

”Your mother has a cancer.”

‘He was silent. The whole room was full of the silence and the weight of what she had said lay upon him.’

In Black Sheep, Evie has noticed her mother-in-law Alice’s increasing fatigue and weight loss – ‘Alice looked as if the tiredness had settled in the marrow of her bones.’ Not content with her husband’s diagnosis of ‘ailing somehow’, Evie challenges Alice to share what she suspects her mother-in-law has been suffering from, and which she has hitherto been hiding:

‘The swelling was the size of an apricot, pushing against the skin.’

What particularly moves me about this passage, is how both women immediately, and silently, acknowledge the significance of the swelling. Reminiscent of Susan Sontag’s kingdoms of the ill and of the well, with a very narrow gap between the two, the chapter ends poignantly, and tenderly:

‘She put her hand on the other woman’s arm and rested it there, and so they stood, both silent, as if they were staring into the depths of the same river but from opposite banks.’

CQ

‘A true tale of love, death and DNA’

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I saw this affecting work last night at Jackson’s Lane Theatre, North London. The Penny Dreadful production is currently on a UK National tour. The play is a profoundly thought-provoking piece, which directly challenges us to consider issues around mortality, immortality, and the ultimate question of what happens to us when we die.

Do we cease to be at that point?

The Henrietta Lack story encourages a consideration of this question. Lacks died as a result of cervical cancer in 1951, at the age of 31. However, the cells from her aggressive cancer, known as HeLa and which contain all the DNA that constituted Lack’s genetic make-up, continue to survive and to replicate in laboratory conditions, producing the first ever ‘immortal cell line’. Despite the dubious ethical issues that surround the original procurement of Lack’s cells (her children were never told, and Lack’s cells were public property until 2013), research based on HeLa has been directly responsible for the development of treatments for conditions such as AIDs, cancer, cystic fibrosis and vaccines, and many more. HeLa cells have also provided the foundation for mapping the human genome.

How To Be Immortal interweaves three true stories: Henrietta Lack’s own story and that of Dr Gey and his wife who ‘discovered’ HeLa in 1951, the story that Lack’s daughter Deborah (1996) was born into (she was a baby when her mother died) but only discovered later in life, and the contemporary narrative of Rosa and Mick. Mick, similar Lack, also has a rare and aggressive type of cancer, from which he dies. The issue of research, using cells from his tumour – this time with consent – is presented to the distraught Rosa. She agrees, and the outcome leads to a healing of sorts. Deborah also seems to experience a coming-to-terms with her mother’s death, and with its aftermath

I applaud the blend of science and of the essence of humanness, particularly its essential vulnerability, that How To Be Immortal successfully balances to create a living performance that raises questions it does not necessarily set out to answer. It is our job, the audience, to consider what has been presented to us:

Who and what are we, and does our ‘make-up’ extend beyond our DNA?

When we die, what do we leave behind? A contribution to some genetic pool, or memories, that may only remain until the death of the last remembering person?

Unanswerable questions, perhaps, but worthy of reflection…

This book was an unexpected delight.

‘Delight’ may not be the best descriptor, as John William’s Stoner is a profoundly sad, at times even bleak read. Yet I felt enriched by the experience. It is truly one of those must-reads.

The title refers to the main protagonist, William Stoner, and the book chronicles his life. We are introduced to Stoner after his death, and from the outset we begin to have a sense of the man and of his life:

‘An occasional student who comes upon the name may wonder idly who William Stoner was, but he seldom pursues his curiosity beyond a casual question…his name is a reminder of the end that awaits them all, and to the younger ones it is merely a sound which evokes no sense of the past and no identity with which they can associate themselves or their careers.’

An only child, Stoner’s parents were farmers. A solitary and mostly silent childhood was spent toiling the physical world of soil and land. Later, he left to study agriculture at university. A required element of the curriculum was English literature, which opened up a previously unknown world to him, one that filled him with wonder and awe. While studying, he dutifully returned home during the holidays to work on the farm. His relationship with his parents remained a largely unspoken one, and Stoner never shared his ‘other world’ with them.

‘He thought of his parents, and they were nearly as strange as the child they had borne; he felt a mixed pity for them and a distant love.’

Discovering a love for teaching, he remained at the university for the remainder of his life, although he struggled to successfully communicate the wonder he himself experienced within, with his students.

The solitary condition of his childhood persisted during his university years:

‘He had no friends, and for the first time in his life he became aware of loneliness.’

However, for a time he did have two friends, one of who commented:

‘You have the lean and hungry look, sure enough. You’re doomed.’

It was a prescient observation, as Stoner’s life proceeded to a succession of tragic episodes, and to a life defined by sadness, an inescapable sadness that he was born into. When his parents died, Stoner reflected:

‘He thought of the cost exacted, year after year, by the soil; and it remained as it had been—a little more barren, perhaps, a little more frugal of increase. Nothing had changed. Their lives had been expended in cheerless labor, their wills broken, their intelligences numbed.’

Any relief that Stoner did occasionally experience from the relentless doom that enveloped his life was short-lived. He married, but it was a failure on every level. They had one daughter, Grace, with whom he was initially very close, but this later evaporated. Having briefly found friendship, his closest friend was killed in the war. He had a lover with whom he had many moments of happiness, but this was poignantly relinquished.

As a result of his life experiences, Stoner mostly lived on the periphery, becoming increasingly detached, dislocated, and numb:

‘…at will, he seemed able to remove his consciousness from the body that contained it, and he observed himself as if he were an oddly familiar stranger…’

‘He felt at times that he was a kind of vegetable, and he longed for something—even pain—to pierce him, to bring him alive.’

The final section of the book, when Stoner is dying, is the most introspective and self-reflective:

‘Dispassionately, reasonably, he contemplated the failure that his life must appear to be.’

Intensely self-critical, and by then utterly defeated by life, he answered his own question on why his life became what it ended up being:

‘What did you expect? he asked himself.’

He is as detached from the fact of his own dying as he has learnt to be about most things in his life:

‘He had no wish to die; but there were moments, after Grace left, when he looked forward impatiently, as one might look to the moment of a journey that one does not particularly want to take.’

The sadness that clings to Stoner’s life is almost palpable. Although unremitting – the reader is never left off the sadness hook – it is impossible to resist reading Stoner. Seduced by the prose and by William’s way of telling, the reader is willingly drawn into a life story that speaks to a universal sadness within all of us.

CQ

I have been thinking about this most unique of relationships, partly in the wake of Medicine Unboxed 2013, and also as I am currently writing chapters for a book on Illness and the Arts.

Jonathon Tomlinson has written a very comprehensive and insightful essay on the notion of the ‘patient’ (http://abetternhs.wordpress/2012/04/09/whats-in-a-name/).

Here, I just want to draw attention to words from those who have expressed their experience of the patient-doctor through their poetry.

Firstly, Raymond Carver, who died as a result of lung cancer, and his poem What the Doctor Said:

‘He said it doesn’t look good

he said it looks bad in fact real bad

he said I counted thirty-two of them on one lung before

I quit counting them…’

Later in the poem:

‘he said I am real sorry he said

I wish I had some other kind of news to give you’

Carver concludes:

‘I just looked at him

for a minute and he looked back and it was then

I jumped up and shook hands with this man who’d just given me

something no one else on earth had ever given me

I may even have thanked him habit being so strong’

This is one of my all time favourite poems. It manages to say so much with so few words – the essence of poetry itself – and within 23 short lines the poem delivers such a strong sense of what the sufferer was experiencing at the ‘other side’ of the desk.

Secondly, to another poet who died as a result of cancer, Julia Darling. The anthology The Poetry Cure, which she edited with Cynthia Fuller, contains much to enlighten those who wish to gain insight into the suffering of illness.

In her poem Too Heavy, Darling directly addresses the medical profession:

‘Dear Doctor,

I am writing to complain about these words

you have given me, that I carry in my bag

lymphatic, nodal, progressive, metastatic…’

‘…And then you say

Where are your words Mrs Patient?

What have you done with your words?

Or worse, you give me that dewy look

Poor Mrs Patient has lost all her words, but shush,

don’t upset her, I’ve got spares in the files.

Thank god for files.’

Finally, also from The Poetry Cure, from Carole Satyamurti’s Out-Patients:

‘My turn. He reads my breasts

like braille, finding the lump

I knew was there. This is

the episode I could see coming —

although he’s reassuring,

doesn’t think it’s sinister

but to be quite clear…

He’s taking over,

he’ll be the writer now,

the plot-master,

and I must wait

to read my next instalment.’

The poets say it all.

I have nothing to add.

CQ

I found much to connect with in David Sedaris’s recent reflective piece in The New Yorker, ‘Now We Are Five’ (http://www.newyorker.com/reporting/2013/10/28/131028fa_fact_sedaris).
Sedaris’s sister, Tiffany, died in May this year, at the age of 49. She committed suicide, and although Sedaris had not communicated with her for 8 years, her death provoked a profound sense of loss.
‘A person expects his parents to die. But a sibling? I felt I’d lost the identity I’d enjoyed since 1968, when my younger brother was born.’
Until May, Sedaris belonged to a family of six siblings. Now, there are five.
‘”And you can’t really say, ‘There used to be six,'” I told my sister Lisa. “It just makes people uncomfortable.”‘

My sister died in January this year. Amidst the multi-faceted and infinite aspects of felt loss, I was unexpectedly struck by how diminished our sibling group has now become. The experience of going from five of us to ‘just four’, felt much greater than the loss of an individual. We seemed to have lost something indefinable that had hitherto made us the family that we had been.

‘Each of us had pulled away from the family at some point in our lives–we’d had to in order to forge our own identities, to go from being a Sedaris to being our own specific Sedaris.’

So too has it been for my family. We probably still do it, that pulling away, but there is always a coming back, even if unpredictable and transient.

The poet and physician Dannie Abse believes that ‘Men become mortal the night their fathers die.’ When the generation that appears to separate you from your own mortality is removed, it is a defining life moment, not merely in terms of the experience of losing a parent, but also in terms of what it means for the living and passing of one’s own life.

The death of a sibling is momentous for other reasons. Yes, it does indeed make you aware yet again of the fragility of life. It also challenges your sense of self and identity, especially that significant part of you that has always been bound up in ‘family’, much of which disappears along with the sibling you mourn.

CQ

I have read two books by Irish authors recently: Kevin Maher’s The Fields and Roddy Doyle’s Guts.
In Doyle’s book, there is an overt cancer theme throughout. For Maher, it is more of a subplot.
What struck me about both, was how the authors used humour.
I laughed out loud, which is very unusual for me, when reading most of Guts. I wondered afterwards how Doyle worked humour around such a serious topic – bowel cancer, unsurprisingly. Humour is not a flippant or reductionist tool in Doyle’s hands. Rather, it invites you in, seduces you into joining the ‘party’, and you feel welcome and involved. The banter and asides, which are all-pervasive throughout, facilitate an expression and a sharing of stuff that might otherwise be unbearable.
Jimmy, who has just been diagnosed, tells his father the news in the pub:
‘— Are yeh havin’ another?
— No, said Jimmy. I’m drivin’.
— Fair enough.
— I have cancer.
— Good man.
— I’m bein’ serious, Da.
— I know.

— Jesus, son.
— Yeah.
— Wha’ kind?
— Bowel.
— Bad.
— Could be worse.
— Could it?
— So they say, said Jimmy.
— They?
— The doctors an’ tha’. The specialists. The team.
— The team?
— Yep.
— What colour are their jerseys?’

In The Fields, the protagonist’s dad has a lymphoma:
‘And Dad, fair dues to him, plays down the whole cancer thing like it’s a very very long and serious life-threatening cold. He doesn’t even use the word ‘cancer’. Ingeniously, he calls it, ‘my neck thing’…
…They don’t know where it came from, but Dad suspects it might be because of the new microwave…
When he walks through the kitchen after that he kind of ducks when he passes the microwave. Just in case it’s still spewing out cancer-causing rays that might start cooking his few remaining healthy cells.’

Both books are works of fiction, and although they deal with very serious topics, these very believable stories of interconnected lives that have been interrupted by illness and impending mortality leave you feeling uplifted and hopeful.
The magic of Irish humour, really…

CQ

The BBC foreign correspondent Helen Fawkes has ovarian cancer. She was first diagnosed 12 years ago and had been in remission until recently. She has now been told that she has incurable disease (http://www.bbc.co.uk/programmes/p01j9ghq).

Twelve years ago, once chemotherapy had been completed, Fawkes wrote a list of 10 things she wanted to do on the back of an envelope. One of the items was to become a BBC foreign correspondent, which she duly achieved. When she was told the diagnosis of recurrent and incurable cancer, she initially focused on the unfairness of it all. Yet, alongside the upset and the anger, she also became determined to live her life that remained to the full. She has written a 50 item to do list, which she prefers to call a list for living rather than a bucket list…

As she ticks off the items – things that celebrate being alive, mostly experiences shared with those dear to her – Fawkes finds that the list has made her excited about life. Now finding herself in a situation where control and structure have largely been eroded, she sees the list as a way of prioritising her time, of minimising regrets, and of helping to ensure that the time she has left is spent truly ‘alive’ rather than on autopilot.

Fawkes questions whether such an approach to life, as in living it ‘to the full’, is inherently selfish, or whether it might in fact be spiritual. There is no simple answer, but I do concur with the psychotherapist Philippa Perry, who suggests that there is something of the shopping list about bucket lists, a sort of consumerist approach to buying one’s way out of feeling what one is feeling…

The artist and senior TED fellow Candy Chang created a thought-provoking visual piece of work around the notion of what we really want to do and to achieve with our lives (http://www.ted.com/talks/candy_chang_before_i_die_i_want_to.html).
Chang turned the exterior of a derelict house in her neighbourhood in New Orleans into a giant chalkboard, where passersby were invited to complete the line, ‘Before I die I want to…’
Within 24 hours, the board was filled with hundreds of messages. The idea has now moved to many other countries, where it has been just as popular. Clearly, people do stop to consider what they would like to do, or perhaps what they dream of doing ‘someday’. Whether this translates into an actual ‘doing’, particularly before one becomes aware that death is much closer than anticipated, is another important and as yet unanswered question.
Chang sees life as ‘brief and tender’. She sees death as an intrinsic part of how we live, and believes that preparing for this inevitable event can not only be empowering, but can also serve to clarify our lives as we live through them.

CQ