One of the angriest people I have ever worked with was a young man with osteogenic sarcoma of the right leg. He had been a high school and college athlete, and until the time of his diagnosis, his life had been good. Beautiful women, fast cars, personal recognition. Two weeks after his diagnosis, they had removed his right leg above the knee. This surgery, which saved his life, also ended his life. Playing ball was a thing of the past.
These days, there are many sorts of self-destructive behaviors open to an angry young man like this. He refused to return to school. He began to drink heavily, to use drugs, to alienate his former admirers and friends and to have one automobile accident after the other. After the second of these, his former coach called and referred him to me.
He was a powerfully built and handsome young man, profoundly self-oriented and isolated. At the beginning, he had the sort of rage that felt very familiar to me. Filled with a sense of injustice and self-pity, he hated all the well people. In our second meeting, hoping to encourage him to show his feelings about himself, I gave him a drawing pad and asked him to draw a picture of his body. He drew a crude sketch of a vase, just an outline. Running through the center of it he drew a deep crack. He went over and over the crack with a black crayon, gritting his teeth and tearing the paper. He had tears in his eyes. They were tears of rage. It seemed to me that the drawing was a powerful statement of his pain and the finality of his loss. It was clear that this broken vase could never hold water, could never function as a vase again. It hurt to watch. After he left, I folded the picture up and saved it. It seemed too important to throw away.
In time, his anger began to change in subtle ways. He began one session by handing me an item torn from our local newspaper. It was an article about a motorcycle accident in which a young man had lost his leg. His doctors were quoted at length. I finished reading and looked up. “Those idiots don’t know the first thing about it,” he said furiously. Over the next month he brought in more of these articles, some from the paper and some from maga-zines: a girl who had been severely burned in a house fire, a boy whose hand had been partly destroyed in the explosion of his chemistry set. His reactions were always the same, a harsh judgment of the well-meaning efforts of doctors and parents. His anger about these other young people began to occupy more and more of our session time. No one understood them, no one was there for them, no one really knew how to help them. He was still enraged, but it seemed to me that underneath this anger a concern for others was growing. Encouraged, I asked him if he wanted to do anything about it. Caught by surprise, at first he said, “No.” But just before he left he asked me if I thought he could meet some of these others who suffered injuries like his.
People came to our hospital from all over the world, and the chances were good that there were some with the sorts of injuries that mattered to him. I said that I thought it was quite possible and I would look into it. It turned out to be easy. Within a few weeks, he had begun to visit young people on the surgical wards whose problems were similar to his own.
He came back from these visits full of stories, delighted to find that he could reach young people. He was often able to be of help when no one else could. After a while he felt able to speak to parents and families, helping them to better understand and to know what was needed. The surgeons, delighted with the results of these visits, referred more and more people to him. Some of these doctors had seen him play ball and they began to spend a little time with him. As he got to know them, his respect for them grew. Gradually his anger faded. I just watched and listened and appreciated.
My favorite of all his stories concerned a visit to a young woman who had a tragic family history: breast cancer had claimed the lives of her mother, her sister and her cousin. Another sister was in chemotherapy. This last event had driven her into action. At 21 she had both her breasts removed surgically.
He visited her on a hot midsummer day, wearing shorts, his artificial leg in full view. Deeply depressed, she lay in bed with her eyes closed, refusing to look at him. He tried everything he knew to reach her but without success. He said things to her that only a person with an altered body would dare to say. He made jokes. He even got angry. She did not respond. All the while a radio was playing rock music. Frustrated, he finally stood, and in a last effort to get her attention he unstrapped the harness of his artificial leg and let it drop to the floor with a loud thump. Startled, she opened her eyes and saw him for the first time. This young man, once one of the best dancers on his college campus, began to hop around the room snapping his fingers in time to the music, laughing out loud at himself. After a moment she burst out laughing. “Fella,” she said, “if you can dance, maybe I can sing.”
This young woman became his friend and began to visit people in the hospital with him. She was in school and she encouraged him to return to school to study psychology and dream of carrying his work further. Eventually she became his wife, a very different sort of person from the models and cheerleaders he had dated in the past. But long before this, we ended our sessions together. In our final meeting, we were reviewing the way he had come, the sticking points and the turning points. I opened his chart and found the picture of the broken vase that he had drawn two years before. Unfolding it, I asked him if he remembered the drawing he had made of his body. He took it in his hands and looked at it for some time. “You know,” he said, “it’s really not finished.” Surprised, I extended my basket of crayons toward him. Taking a yellow crayon, he began to draw lines radiating from the crack in the vase to the very edges of the paper. Thick yellow lines. I watched, puzzled. He was smiling. Finally he put his finger on the crack, looked at me and said softly, “This is where the light comes through.”
Suffering is intimately connected to wholeness. The power in suffering to promote integrity is not only a Christian belief, it has been a part of almost every religious tradition. Yet 20 years of working with people with cancer, in the setting of unimaginable loss and pain, suggests that this may not be a spiritual teaching or a religious belief at all, but rather some sort of natural law. That is, we might learn it not by divine revelation, but simply through a careful and patient observation of the nature of the world. Suffering shapes the life force, sometimes into anger, sometimes into blame and self-pity. Eventually it may show us the freedom of loving and serving life.
- Rachel Naomi Remen, M.D.