Living with Uncertainty: When Will I Die?

An Excerpt from Storied Companions

Karen Derris

Dr. Karen Derris is a scholar of South and Southeast Asian Buddhist traditions and professor of religious studies at the University of Redlands. Her research focuses on the intersection of literature and feminist ethics in pre-modern Buddhist traditions, particularly focusing upon the central importance of community in Buddhist ethical and spiritual development. Dr. Derris received her PhD from the Committee on the Study of Religion at Harvard University in 2000.

The following is an excerpt from her new book, Storied Companions.

 

 

“Why me?” is a stupid question, or more gently, an unproductive one. There are known contributing factors for some forms of cancer, but even then, a causal relationship can’t be definitively proven. And anyway, it can seem like blaming the victim. We get sick and we die because of impermanence. There is no arguing with that foundational Buddhist teaching.

“When?” is a question most people avoid. Or answer by assuring themselves and others that their time is a long way off. As though not knowing the time of death guarantees that it is nowhere near to now. This question comes into sharper focus when the conditions leading to death are known, felt, and are directly shaping one’s daily patterns of living.

I’ve largely (but not completely) avoided the “why,” but figuring out how to live with the “when” is very hard. Those series of two months between brain scans initially brought some relief—even comfort—in their regularity, and in the fact that we would leave San Francisco with the news that the tumor was still stable. But then, a few days before the checkup process approached, my horizon would begin to feel unstable again. There is forward motion, but it felt like I was constantly stumbling, tripping as I moved toward the next MRI looking for changes in the tumor as the sign or progression of the cancer.

My honest, ethical doctors are upfront about the imprecision of the available tools for making these assessments. Ed refers to the MRI measurement tools as Etch a Sketches, as they appear on the computer screen like our childhood toys. In any case, my repeated pleas for a prognosis are dependent on the interpretation of when all this began. Time, again, is the issue. “When” isn’t just a matter of conclusion, but of the start of all this as well. When did they arise, these conditions that created the present and are determining my future? When did my brain cancer begin? Was I born with it? Unlikely. Did it begin when my mom broke the bottle on my skull? Impossible to know. When I am injured in the car accident that killed my mom? Some doctors consider that possibility, others give a definitive no. Most of us live with uncertainty of how to frame the time of our life and life experiences.

The way we live in time is a condition for living well. My visceral memories of my past made possible the work of setting down my anger and fear. While I no longer cling to those memories, or at least to the pain of those events, they continue to help me know the conditions of my present and shape my concerns for the future too. I often hear or read that people who experience severe illness, or an event that brought death into focus, gain a new appreciation for living in the present moment. That’s great; but I’m not sure I totally buy it. Or, it doesn’t release me from a more complicated relationship to the time frame of my life.

When does our “when” begin? In many worldviews—religious or philosophical—it is at birth. But what about before that? The Buddhist process of rebirth is an opaque filter, another form of knowing that there is much we do not know about ourselves. We know that we generated karma in pasts that far preceded our birth into this life, but we do not, and cannot, know anything about the causes of that karma or its current effects. Only the buddhas know such a thing; the Pali texts tell us that the vision to see our own and others’ past and future lifetimes is gained only on the second stage of awakening.

So, again, is the question of when this illness began a productive question? From a doctor’s perspective it is relevant for both diagnosis and prognosis. This is one of the interpretive levers that makes my future unfixable: Do we take as the cancer’s starting point that MRI in 2002 that first shows the tumor? Or the 2014 craniotomy that brings me the diagnosis of grade II glioma brain cancer? Or does the clock reset in 2017, with the second craniotomy that diagnoses grade IV glioblastoma, one of the deadliest forms of cancer? If doctors start the measurement of my prognosis in 2014 or earlier, then my current longevity goes beyond any of the statistical charts. If 2017, then my prognosis probabilities are scarier; I may be dead when you are reading this. My oncologists don’t with absolute certainty when the beginning begins.

I find myself shifting between these different temporal contexts quite often in my attempts to accept the uncertainty as a primary dimension of impermanence. My pole star is my children. How old will they be in two years? In six? In ten? I’ve told my oncologist that my goal is to live until my youngest leaves home for college. His nod acknowledges that hope, but he can’t responsibly reassure me that this cancer, at least, won’t be the obstacle to reaching that goal. He cannot predict the success of my aspiration.

"Most of us live with uncertainty of how to frame the time of our life and life experiences."

My progressively dire diagnoses and my decreasingly hopeful prognoses have created a new and distressing relationship with time. I long to live within the structures of Buddhist stories when a Buddha predicts the future, in particular, those stories, found in many Theravada and Mahayana scriptures, that offer a bodhisattva—a buddha-to-be—a detailed blueprint of their future.

The most famous story in Theravada literature of a bodhisattva’s prediction of future buddhahood is made by the buddha Dipamkara to our Buddha, Siddhartha Gautama. Once upon an unimaginably long time ago, the bodhisattva who would become Shakyamuni Buddha was a young man named Sumedha, who in adulthood renounced his life as a householder after the death of his wealthy parents. Seeing the meaninglessness of wealth in the face of their death, he gives it all away and retreats to a solitary, ascetic life in the mountains.

One day, news reaches him that a buddha, Dipamkara, was on his way to the village far below him. Dressed only in a bark cloth, Sumedha descends by means of his power of flight (attained through his advancement) and joins the crowds preparing the roadways for the arrival of the buddha and his monastic community, or sangha. Their aim is to make the road perfectly smooth and beautiful as an act of veneration. 

Sumedha finds a spot of the road still muddy and unprepared for Dipamkara, who is quickly approaching, and lies down in that mud, making his matted hair and body into a bridge for the buddha and his seemingly infinite line of monks to walk across. Coming to Sumedha’s prone form, now prostrate in a posture of worship, the buddha Dipamkara halts his procession, his feet directly pointing at Sumedha’s head. In this most auspicious moment of opportunity, Sumedha makes an aspiration for his future: he vows that, in a lifetime so many years away in the future they couldn’t be counted, he too would become a buddha, just like the buddha Dipamkara, who then stood upon his hair.

All buddhas are said to embark on the bodhisattva path in this manner: with a vow made before a buddha, to attain complete and perfect enlightenment for the benefit of all. Upon receiving Sumedha’s aspiration, the buddha Dipamkara then fulfilled his role in the story by confirming the vow and providing a prediction of its fulfillment. He closes his eyes and sends his consciousness into an examination of the future. Returning to the present moment, he reports on what he has just seen: in a specific future Sumedha would become the Buddha Shakyamuni. The prediction includes a great many details of the future life when he would live as that buddha, including the names of his family members and the circumstances of his birth, renunciation, and awakening to buddhahood.

Dipamkara’s abilities to know the future are accepted by all as a fact of a buddha’s omniscience. So much so that everyone who hears it that day shares in the reassurance that this was not just a possible future, but a future that they could be sure of. Moreover, it was a future they could be a part of; those members of the sangha who lacked the confidence that they could attain liberation in that life vowed that they would do so during the lifetime of Shakyamuni. Dipamkara’s prediction gave them certainty of their future, too.

"I long to live within the structures of Buddhist stories when a Buddha predicts the future."

I have long been fascinated by the Sumedha story, years before cancer became a condition of my life. I lived with it intimately for months as I wrote about it as the central narrative for my doctoral dissertation. I came to know it in a halting, disrupted way as I attempted to find the best forms of expression in English and translate it from the canonical Pali Buddhavamsa and also from medieval Pali commentary. As was appropriate for the task of writing an academic thesis, I was focused on my analytical interpretations of the story for my arguments on relational ethics in Theravada literature. I focused particularly on the relationships of buddhas and bodhisattvas still on the path to awakening. That goal cannot be achieved by an individual alone, I argued, but only through the supporting relationships of many others. In spite of my practiced academic critical distance, the story did become a part of me. I thought of it constantly as I walked around Manhattan, where I then lived. Phrases and words echoed in the background of my mind. Scenes played out for me, on a block ahead of me, on the busy streets of the city, floating above the crowds of people at an intersection waiting on a sidewalk above a muddy gutter.

My own past self, that young, healthy student, attempted to understand the relationships among buddhas. My focus was entirely upon those past, present, and future buddhas. I wasn’t much interested in what was happening to all the ordinary people in the crowd around them. Experiencing this story now, my illness brings me into the crowd, a crowd of people, who, like me, know that their present is limited and perilously uncertain.

Rereading this story with my now-shaky grasp of time, I view it from a different perspective. I no longer read it from above with a spotlight on the bodhisattva’s aspiration for the future and the buddha’s prediction that time will absolutely unfold precisely as foretold. A clear prediction of my remaining time, I had thought, would make my diagnosis and prognosis bearable. As I moved through the stages of treatment, I began to rethink the purpose of the prediction stories that I studied for so long. They were not only for the sake of the bodhisattvas who receive them. They were intended also for those following behind the exalted beings on the path, those people in the crowd who would be reassured by a known future, one in which a buddha would be present to care for them.

This story gives me two possible ways of relating to time: a clear view into a known future and a conditional view that can’t tell me anything in absolute terms. I want an unconditional declaration of my future with cancer. In my illness I want my own prediction. I want to know where I stand now in the timeframe of my own life. I want the clarity of a definitive prognosis, not the foggy, groggy prognostication of statistical tables. I don’t want to pine for the possibility of a new clinical trial opening up in time that might extend my life, should I meet the necessary conditions for that trial. The future that I live toward is infinitesimal compared to the temporal frame of this Buddhist story. I’m not hoping for a geological leap across millions of years in time. I desire to know: will I live for six months or seventeen? For a year or for years? How many? I want to know for certain what this cancer was going to take away from me and when. I want what I cannot know. There is something important in my not-knowing. The impermanence and interconnectedness of time is real. Really real. My cancer makes me see it, deal with it, live with it, grow and transform with it.

"The impermanence and interconnectedness of time is real. Really real."

Facing a terminal cancer diagnosis, Karen Derris—professor, mother, and Buddhist practitioner—instinctually turned to books. By rereading ancient Buddhist stories with fresh questions and a new purpose in mind, she discovered evolving ways to make them immediate and real. Storied Companions interweaves Karen’s memoir of her lived experiences of trauma and terminal illness with stories from Buddhist literary traditions, sharing with the reader how she found ways to live fully even with the reality that she won’t live as long as she needs—or wants.

Using her knowledge, practice, and imagination, Karen illustrates how placing yourself within narratives can turn them from distant and static sources into companions, and from companions into guides. Reading along with her, you’ll realize how this practice of reading and these ancient narratives can help us come to terms with impermanence, develop empathy and compassion, and realize our own interconnectedness.

Honest, powerful, and insightful, Storied Companions itself becomes an invaluable companion, guiding the reader to discover new ways of facing and experiencing life, death, and impermanence.

 

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