Writing about the certainty of death

Anatole Broyard, Intoxicated by My Illness (New York: Ballantine, 1993). 156 pp. $15.00.

Patrick Kurp has a long satisfying post up this morning about the poet L.E. Sissman, who died of Hodgkins’s disease in 1976 just about a decade after first being diagnosed with the disease. “No one,” Patrick comments, “has written so unromantically and with such wit about the certainty of a foreshortened life. . . .”

The lack of romance is the keynote of Sissman’s poetry, but it is also the key to writing about the certainty of death. Sentimentality or self-pity mars most such writing, and renders it useless for anyone who looks for help in how to think about his fast-approaching death. There are not many writers who are both clear- and tough-minded in the face of death.

One other is Anatole Broyard. A longtime book critic for the New York Times, Broyard is remembered now largely because he was an African-American who “passed” for white in an age when “passing” had long since ceased to provide any advantages. In his biographical essay “The Passing of Anatole Broyard,” Henry Louis Gates mentions Broyard’s prostate cancer (although he mangles the diagnosis somewhat) and also the critic’s characteristic reaction to it:
Broyard spent much of the time before his death, fourteen months later, making a study of the literature of illness and death, and publishing a number of essays on the subject. Despite the occasion, they were imbued with an almost dandyish, even jokey sense of incongruity: “My urologist, who is quite famous, wanted to cut off my testicles. . . . Speaking as a surgeon, he said that it was the surest, quickest, neatest solution. Too neat, I said, picturing myself with no balls. I knew that such a solution would depress me, and I was sure that depression is bad medicine.” He had attracted notice in 1954 with the account of his father’s death from a similar cancer; now he recharged his writing career as a chronicler of his own progress toward death. He thought about calling his collection of writings on the subject Critically Ill. It was a pun he delighted in.And that’s it. One expects more basic (and accurate) information from a critic of Gates’s standing.

The collection of writing on Broyard’s “progress toward death” was published posthumously as Intoxicated by My Illness. It concluded with the brilliant story “What the Cystoscope Said,” first published in the Pocket Book collection Discovery #4 edited by Vance Bourjaily and reprinted in Fiction of the Fifties (1959) edited by Herbert Gold. The narrator never identifies the cancer that kills his father. (Broyard’s own father died from cancer of the bladder.) The cystoscopy that unmans him, the “little surprise” that Peter Romain receives from his doctor “to get the inside story on you,” is a test to measure the health of the urethra and bladder. It is commonly administered to differentiate bladder from prostate cancer.

Gates mimics the euphemistic language of the story’s doctor, who describes Romain’s cancer as “incurable” (Broyard’s was “inoperable,” Gates primly says). It would be more direct and accurate to say that both men had a cancer that had similarly metastasized. As Dr. Windelband says to Romain’s son, “The cancer has reached his bones.” Despite advances in medicine, Broyard was no more fortunate forty years later. When it is localized, prostate cancer is one of the most curable cancers; according to the American Cancer Society, the relative five-year survival rate for men with localized prostate cancer is 100%. When it “spreads” to the bones or lymph nodes, however, average survival time is one to three years.

Broyard got fourteen months. During that time he wrote a number of short essays, delivered a talk at the University of Chicago Medical School, and sporadically kept a journal. From this material his widow extracted four essays and not quite ten pages of notes and reflections.

The tone is established at the outset. “I felt something like relief, even elation, when the doctor told me that I had cancer of the prostate,” Broyard writes. Gates describes this as “dandyish, even jokey,” but Broyard is neither striking a pose nor cracking wise. “When you learn that your life is threatened,” he explains, ”you can turn toward this knowledge or away from it.” What follows is an object lesson in turning toward the knowledge of one’s near death.

It is more than a matter of intellectual honesty. A sentence of death can be a gift—deliverence from the unknown into the cause of urgency. One is narrowed to the immediately relevant and no longer responsible for social expectations or graces:
I can’t help thinking there’s something comical about my friends’ behavior—all these witty men suddenly saying pious, inspirational things. They are not intoxicated as I am by my illness, but sobered. Since I refuse to, they’ve taken on the responsibility of being serious.Perhaps Gates cannot tell the difference between jocularity and wit. Jokes are appreciated by academics, but not an assemblage of Ideas put together with quickness and variety. Wit is Broyard’s weapon against despair, but also the preservation of his identity. He is defined, not by his cancer, but by his thought and words.

The best thing in the book is the long essay “The Patient Examines the Doctor.” Although he does not abandon his epigrammatic and allusive approach (his talent for developing a scene or argument was damaged by nineteen years of writing a regular book column for the New York Times), Broyard circles around and around a sharp and significant point. From his side, the patient and his doctor are a couple (“what the French call un couple malade, a marriage of doctor and patient”), which the doctor would do well to understand. Instead, the relationship between doctor and patient is too often like a marriage in which husband and wife no longer talk to each other. Broyard’s doctor was a famous urologist:
He knows all there is to know about the prostate, but I cannot sit down and have a talk with him about it, which I find a very great deprivation. . . . What a curious organ. What can God have been thinking when he designed it this way? I would like to have a meditation, a rumination, a lucubration, a bombination, about the prostate. I can’t do it. I’m forced to stop people on the street and talk to them about it.Okay, the last line is a joke. Until then, though, Broyard is making a serious point. A patient’s feelings toward his doctor are like the love that a wife feels for the husband who has fallen out of love with her. The problem is that most doctors cannot locate a middle ground between brutal directness, in medicine’s technical vocabulary, and pious, inspirational banalities.

If only for reprinting “What the Cystoscope Said” in a collection of Anatole Broyard’s own writing, Intoxicated by My Illness would deserve praise. It is better than that, however. It is capable of teaching physicians—teaching all of us—a different language for terminal disease.