The Last Days of Susan Sontag

Her son wonders whether the living should offer hope or truth to the dying.

SWIMMING IN A SEA OF DEATH

A Son's Memoir

By David Rieff

Simon & Schuster. 180 pp. $21

The title of David Rieff's new book is grim but apt. Three years after his mother, Susan Sontag, died, Rieff remains deeply immersed in her last illness: its momentum, its personalities, even its language. In 2004, Sontag was diagnosed with myelodysplastic syndrome, a deadly form of leukemia. She chose to fight the disease with radical treatment, having successfully battled earlier bouts of breast cancer and uterine sarcoma. It became the task of her son and her friends, and to some degree of her doctors, to offer hope all along the way that there was a chance, however small, to bring the disease into remission.

Rieff describes with piercing accuracy how loved ones of the terminally ill pick their way unsteadily between realistic prognosis and meaningful support, between truth and hope. To maintain one's emotional balance while a dying parent fights for her life is an excruciatingly painful and exhausting exercise. One has to accept the probability of death and the authenticity of the struggle for life -- both at the same time. For a very small percentage of terminal cancer patients in even the worst cases, remission can occur. Somebody, after all, gets to be part of that lucky group.

While his mother was sick, Rieff, a contributing writer for the New York Times and author of seven previous books, chose not to write about her illness, not even to take notes or write in a journal. To do so seemed to him both distancing and futile. "What my mother and I shared were words," he writes, "and yet now they felt all but valueless -- like Confederate dollars or Soviet roubles."

Instead, he became a companion, a confidant, an adviser and a research assistant. He helped his mother to investigate every aspect of the disease, to work with a series of doctors whose medical conclusions and interpersonal skills varied widely, and to explore any potentially helpful treatment, however minuscule its chance of effectiveness. He offered her the reassurance she desperately craved, telling her what she wanted to hear and what he did not believe: that against all the odds, she could survive.

Rieff describes with admiration the ability of skillful physicians to convey the medical reality and give encouragement simultaneously. With the advantages of experience, objectivity and access to promising new treatments, they are able to envision not only the worst but also the best of possible outcomes, so that a Parisian oncologist could write honestly to Sontag after viewing her slides, "I do not think your case is hopeless."

For Rieff, though, his mother's situation was catastrophic, and the choice "boiled down to hope or truth." By choosing to give her hope, he wonders now whether he "might not have made things worse for her." He raises an impossible question, one to which there can be no answer.

A fast-moving cancer is a vortex of tremendous force, drawing everyone around the sick person into a dark spin of diagnostics, drugs, doctors, hospitals, "procedures" and treatments, with little room left for emotional exploration. It is only after the inevitable death that the burden of feelings that survivors have carried can be examined. The most tenacious of these is often guilt, not so much the guilt of survivorship as the guilt of helplessness, the feeling that one should have done something more.

Rieff's book is suffused, almost tainted, with self-questionings, but he writes so well that instead of muddying the narrative with these, he offers a clear and rare perspective on the dilemma of the loving witness -- spouse, partner, sibling, child. On the one hand, he must absorb the full enormity of the disease in its every detail and implication. On the other, he must give his sick mother what she needs most, even if what she needs most is a lie that seems to contradict everything in her character, and in his.

To be in such a position means being divided against oneself during one of the most intense events a life can hold. To describe this position so unflinchingly, and with such eloquence, means that David Rieff is his mother's son. *

Reeve Lindbergh has written a number of books for children and adults. Her next book, "Forward From Here: Leaving Middle Age and Other Unexpected Adventures," will be published this spring.