What if you only had six more years to live?

I've been thinking quite a lot these days about priorities. Although I'd love to be a model cancer survivor and attribute this to cancer, in all honesty it's something I contemplated a lot even before cancer. Of course, cancer has helped me understand priorities in a different way than before. I've always tried to make time for things that are important to me, and live my life in a way that would leave me with no regrets, but there was always an underlying assumption of a normal timeline for my life, one in which I would live to be at least 80, and where my early 40s would truly be 'midlife.' There was always the 'what if?' element, for sure, but in the past that 'what if?' scenario usually involved some statistically improbable freak accident that I couldn't really plan for anyhow, so why waste time thinking about it, other than maybe buying extra life insurance? Now that 'what if?' scenario is much more tangible, much more real. The possibility of having limited time isn't just some crazy scenario I conjured up in my mind; it could actually happen. And if it does, there's a very real timeline attached to it.

What moved me to write this entry was an article I read this morning. I've mentioned that I teach biology. One of my colleagues sends out a 'Biology of the Day' e-mail every day that is a round-up of all of the major biology news, from mainstream news sources such as CNN to major science journals such as Nature to obscure journals like the Journal of Eukaryotic Microbiology. It's actually an amazing resource for me that helps me stay current in my biology knowledge and oftentimes gives me interesting material to share with my students. Unfortunately, I rarely have time to click on all of the links in the e-mail, so I pick and choose based on my own interests and what I'm in the mood to read about at the particular moment in time I happen to open and read the e-mail.

One of the links in this morning's e-mail was to this article, about a project called 'Photo Ark,' which is a project to capture portraits of all of the world's animals, especially endangered species. I clicked on it because... well, okay, I'll admit it, I like looking at pictures of animals (and so do my students!). And once I clicked on it, I saw that the photos were by Joel Sartore, and I was even more interested. Joel Sartore is a photographer for National Geographic magazine who lives in Lincoln, Nebraska. I first became familiar with his work while I was living in Lincoln, Nebraska, and read a piece that he wrote about Nebraska in National Geographic. After a minor amount of stalking investigating, I realized he lived very close to me, and somewhat marveled at the fact that this world-renowned photographer hailed from the town I was living in, yet received virtually no attention. (Nebraskans are much more into their football heroes.)

Anyway. The point is that if it had been anyone else, I probably wouldn't have scrolled past the gorgeous picture of the African white-bellied tree pangolin. But it was Joel Sartore, so I read the article. The article explained how his 'Photo Ark' project had started. It explained how he was always traveling around the world on photo shoots, while his wife was staying at home with their three kids, until... his wife was diagnosed with breast cancer in 2005, and had to undergo chemotherapy, radiation, and surgery. So he had to stay at home and help out for a year. And while he was at home, he started photographing animals in the local zoo, and the project was born. 

Sadly, his wife's cancer returned in 2012. The article did not elaborate on this, of course, because it was really not an article about his wife's cancer. I'm sure I'm, like, the only person who read it who was more interested in his wife's cancer than of his pictures of naked mole rats. But the article concludes with the following: 

Kathy’s cancer came back in 2012; she had a double mastectomy. That same year, their son Cole, who was 18, was diagnosed with lymphoma. Both recovered, but the illnesses have left their mark. “We don’t get uptight about too much anymore,” Sartore says.

Photo Ark has changed him as well. “It has made me very aware of my own mortality,” he says. “I can see how long it’s going to take.” If he can’t finish the job—he still has thousands of species to photograph—Cole will take over. “I want the pictures to go to work,” Sartore says, “long after I’m dead.”

Perhaps this struck a particular chord not just because I've been contemplating my mortality a lot lately, but also because I've been working on a major career change at the same time. And I want to be clear: the career change has nothing to do with cancer. I was working on it long before the cancer. Interestingly, cancer has added a new sense of urgency to this goal, while at the same time making me doubt whether it's something I should bother pursuing. On the one hand, there's that voice inside me saying all sorts of clichés to the tune of 'just do it!' On the other hand, this career change involves up to three years of schooling for me, which is not trivial, especially considering I am 41 years old and have a family, who will be greatly affected by this. My husband and I have discussed this at length, many times over, and agree that long-term, this will be good for the family, and we can make it work, and in the large scheme of things, three years is not a long time. 

But that 'three years is not a long time' mentality assumes I've got, like, 40 more years in me. Of course I hope that I do, but what if I don't? What if, say, the cancer comes back? The good news of my prognosis is that there's supposedly a good chance the cancer won't come back. The bad news is that due to my age and variables that are not well understood at this point in time, if the cancer does come back, there's a good chance it will come back as metastatic, terminal cancer. 

If I weren't contemplating this major career change, I'm sure I wouldn't be spending nearly the amount of time thinking about this as I am now. I'd just go about my job and home life trying to make the most of each day, checking items off my bucket list, and working toward that 'life with no regrets.' And while I see no compelling reason to derail my plans for the future by convincing myself of a worst-case scenario, it's hard not to ask 'what if?' Are the plans that I have for my future what I want to be doing if I only have, say, six more years to live? I'm not sure why I chose six years, but I guess I'm giving the cancer a few years to come back, then figuring I'll live a few years after that.

Six years, it's reasonable. 

Then I ask myself... suppose all goes as planned, and next summer I'm in school for my new career. What if, at some point, during school or immediately afterward, I discover that the cancer has come back, and it's metastatic? What would I do? If I'm still in school, would I finish school with the optimistic hope that I will beat the odds and live for many, many more years, or would I immediately drop out of school and spend every precious last minute doing the things that 'really matter'? If I've already finished school, would I be angry that I spent the last three years of my life working toward a career I'll never have, or will have for only a few years?

Ultimately, I've decided to go ahead, full force, with the career change. Although it goes against my pessimistic nature, I am also a scientist who believes in data and statistics, and data and statistics tell me there is no reason to be pessimistic. But the decision comes with some caveats, and those caveats center around worst-case scenarios. My new litmus test goes something like this: suppose in the near future, I find out I have terminal cancer, and will likely only live for a few more years. Would I regret how I spent the previous years? If the answer is yes, it's not okay. Whereas before, I saw a reasonable amount of suffering as some path to a better future, I'm not willing to risk that anymore. If the experience is truly unpalatable, it is not worth my precious time, regardless of whether I'm going to live for six more years or sixty. Of course, no experience can be 100% positive 100% of the time, so it's not as if I'm going to say, 'Oh yeah, I had a shitty day/week/month, so I give up!' I'm just thinking that for me, no matter what, there needs to be some reward in the process; that the process must not just be some means to an end... because there might not be an end destination, other than an untimely death. Maybe the present is all there is.

The neurotic, control freak in me needs to have a plan for everything. It's a strength and a weakness. And although I know there are no easy answers, I leave you with some questions. What if you knew you only had six more years to live? Would you live differently than if you had 20, 30, or 40 more years to live? Or... what if you were told you only had one year to eighteen months to live? What would regret?

These are the things I think about a lot these days.