LET ME BEGIN with some facts. My right breast was removed in 1976 using modified radical surgery techniques. It is almost impossible to put into words the shock and terror you feel when you learn you have this dreaded disease.
Your emotions run the gamut from disbelief to fear to feeling of great loss. Disbelief, because cancer is always something that happens to the next person, not to you. Fear, because everyone living in this society has been conditioned to believe that a diagnosis of cancer is equivalent to a death warrant. It is not true, but that is the popular conception. Accepting our own mortality is difficult under any circumstances. But in a society which finds euphemisms for the very word "death" and which encourages its people to pursue youth with a vengeance, it is doubly difficult We come to the task ill-equipped, and our society does little to help prepare us.
No one in my family had ever had cancer, as far as I was able to learn. I was in my late 30s and had never in my life had a major illness of any sort. The only operation I ever had was a tonsillectomy, which was done when I was a child in the doctor's office. I simply could not and would not believe that my age and with my health I could possibly have cancer. But it was a fact I had to face. My doctor was encouraging after my mastectomy and indicated there was little chance of reoccurrence.
I dealt with the situation by denying that possibility. I went through the operation, forced myself back to work in less than two weeks and promptly attempted to forget all about it. I chose to deny rather than to deal with the myriad conflicting emotions that one needs to face and understand.
Despite my efforts, it proved impossible to totally blot out what had happened. Whenever you have had a disease that may reoccur, you become very sensitized to the messages that your body sends to your mind. Whether it is a cold or a simple ache or pain, you experience the fear that this might signal a reoccurrence of some sort. And that fear brings with it the larger fear that the disease will inevitably cause your death. It is essential to face these fears and to come to terms with them, for you will know no peace until you do.
Fortunately, there is a very positive side to this confrontation -- I learned for the first time to listen to my body and what it was saying to me. But this self-knowledge did not come quickly or easily.
After my operation I submerged myself in my work and became the picture of the traditional workaholic. I surpose I fell prey to the "macho man" complex; I wanted to prove to myself and those around me that my illness was just a minor happenstance and did not really affect my life. However, about seven months after I became chief justice, I noticed a very small nodule on the muscle above where my breast was removed. It was at this juncture that I was forced to contront all the frightening possibilities that I had been unwilling to face before.
My surgeon removed the nodule in his office and told me that he would let me know the pathologist's findings. He called me a few days later during the Los Angeles calendar of the court and told me what I had dreaded and had hoped never to hear. It was cancerous. It was a reoccurrence. He said we had to talk about what the next steps should be. He would see me that following Monday when I returned to San Francisco.
I cannot begin to explain what a devastating blow that news was to me. However, I was in the midst of a very heavy calendar of cases and had little time to ponder the situation. Besides, I did not want to worry my family or my staff, so I kept the news to myself.
I kept my appointment with my doctor. Unfortunately, he could not keep his with me. The nurse greeted me with tears in her eyes. She was very sorry, but my doctor would not be able to see me because he was unable to leave his home. For the first time I learned that he, too, had cancer. His was of the pancreas, and they did not expect him to live very long. He died about three weeks later, and I was never to see him again.
This shock was one that sent me reeling. How was it possible that my surgeon, who had seen me through so much, was himself a victim of cancer? How could this have happened? How could I cope? Whom should I see? What should I do? If the medical establishment was unable to save my doctor, whom could they save? It was a terrifying revelation, and it made me very skeptical about whether doctors really could treat this disease and about how advanced the state of the art really was.
As a direct result of these two circumstances, I went through a type of catharsis. I began to read as much of the literature as I could. I felt I needed to know as much as the doctors did. For the first time since my mastectomy, I forced myself to fact the statistics on breast cancer and the mortality rates. And for the first time in my life, I had to seriously consider the possibility that I might have only a few years left to live.
As I observed earlier, this society does not prepare us very well for that eventuality. During most of our lives, we deny, defy or attempt to ignore the fact of death. We place our old people in homes or hospitals beyond our line of sight so that we need not face their suffering -- out of sight, out of mind, as the old saying goes. We would worship instead at the fountain of youth. We sand our skin, lift our chins and dye our hair or replace it. We fool ourselves by creating an illusion, instead of marking proudly the milestone that each gray hair and wrinkle signify.
When you face the fact of your own mortality, you must also face the facts about what you have done with your life. In a peculiar way, death can teach you what life is all about. It is a painful lesson and a difficult journey, but I am personally grateful that I was made to travel this path at a relatively early age. For I have learned much about myself, much about what I want out of life and much about how precious life and people are. It is our relationships with others, especially those whom we love, that give the fullest meaning to life. I don't think I ever really knew that, emotionally or intellectually, until my second bout with cancer.
After my second operation, I set about trying to modify my behavior so that I might live a healthier, more normal life. i changed my diet to one that largely consists of fresh fruits and vegetables, with little or no meat. There are some in the field who believe that stress may suppress the immune system, so I tried to deal more effectively with the stresses in my life. However, my personal experience with cancer was not at an end.
A few months after a particularly nasty and personalized political campaign in the fall of 1978, I had my second reoccurrence. As a result of my previous self-evaluation, I found myself in much better shape to handle this last blow. I surpose the greatest problem for a person suffering from a disease like cancer is the feelings of helplessness and loss of control, as well as the gnawing sense of inevitability. You hope and pray for remission, but each reoccurrence reinforces the fear that death, and a painful one at that, may be unavoidable. I believe it is important to maintain a positive frame of mind about cancer, but I would be less than honest were I to tell you that it is always possible to do so.
Thankfully, there are today many hopeful signs in the treatment of cancer. It does not mean an automatic death sentence. But it is a disease for which there is currently no complete cure. That is a reality which each person who contracts cancer must acknowlege. The fact also presents special problems for the doctors who treat cancer patients. With many other diseases, there are proven cures, tried and tested plans of treatment, courses of action that bring respite and relief. With cancer, there is only trial and error, remission and reoccurrence, expectation and frustration.
Cancer is a difficult disease for the patient to deal with for some of the same reasons that it must be frustrating for the doctor. The patient must come to terms with the fear of deth in a society that denies death's existence. The patient must deal with a disease that makes him or her feel helpless, since the conventional courses of treatment give the patient absolutely no role to play. All too often, the patient becomes a passive object for the interplay of surgery, radiation and chemotherapy. The surgeon's knife, the nuclear medicine machine and the vial of toxic chemicals become the actors in this drama, and the patient is simply written out of the script. There is perhaps no feeling more helpless than that. It's your life, but you no longer have any control over it. I think that is a principal reason why patients find cancer so very difficult to deal with.
The doctor also has a diminished role to play, for he has no cure. He is no longer the traditional giver of life. He will be challenged more often by frustrated and frightened patients. He will feel that he has lost a measure of control over his professional like. Understandably, many doctors feel threatened by these encounters.
However, if doctors allow patients to play a part in formulating a treatment program, the patients become less like objects to be acted upon and more like individuals who can take responsibility along with their doctors in dealing with a disease for which neither of them has the answer.
During the two reoccurences that I have had, I have been in the public spotlight. Anyone who has been in public life during times of societal transition can tell you that a best it amounts to cruel and unusual punishment. If you do not come to terms with the spotlight's constant focus upon you and the unrelenting criticism that comes with that public glare, it would be impossible to remain in the position.
If I had not come to terms with the jpossibility of my own death and my mortality, if I had not been able to accept the fact that I had cancer and to face the fears that cancer creates, I would have been devastated by many of my everyday experiences. Let me provide you with an example. About one week after my third operation was discussed in the press, one of my most vocal critics began to make public speeches about the importance of getting rid of the "cancer" at the top of the court. That, of course, was a euphemism for getting rid of me. I was surpised at the venom that such a statement revealed, but I was able to keep some perspective and even my sense of humor about it precisely because I had come to terms with my disease.
For those who are facing this disease and for those who may one day face it: Have courage, face the facts and you will find that when you have faced your fears and stood your ground there occurs a kind of liberation. It is not an easy journey. It can be quite painful and lonely. But it is a journey that must be made.
It is not a hopeless situation. It is neither too painful nor too fearful to face. Most importantly, it is an opportunity to find out about life. And isn't that really why each of us has been placed here?