Men, Strength, and Death

True strength does not require denial of reality, but suppleness in meeting it.

An individual therapy client of mine told me last year about his soon-to-be-ex wife’s statement of disappointment and disapprobation. “You were supposed to be my John Wayne.”  She said this in the context of a couples therapy session as the two were taking a final step toward divorce.  I heard about the shame reaction that this man had in not being all she had wanted, and the impossibility and awful setup of even trying.  This was the first he had been told overtly of his expected role, and while he might have signed up for it when she disclosed the plan when they started 25 years earlier, he knows better than to take on that role now. Or does he? Do you? Do I?

What is the real measure of a man? What is true strength in the face of a relationship? Of pain? Of death? Shortly after the statement by my client, I sat with my dear friend Rupesh and we riffed a bit on this topic. John Wayne came up in our conversation also.  (Poor guy is still carrying the weight of this role even after he has turned to dirt … .)  I told Rupesh about four male friends who were all dealing with cancer at that time.

One has decided he will beat the disease, and use his diagnosis to become the best pancreatic cancer therapist in the world.  He says that as long as he can use meds to stay just ahead of the physical pain, he is clear that he can beat it. He only gets scared when the pain pushes through.

Another guy is in hospice and receiving palliative care. He doesn’t want his doctor to tell him how much time he has left. “What good is that, and how accurate could it be?” he asks. He just wants to be as fully conscious as possible in the days he has left. He also wants to do all he can to clear up his affairs before he dies so that his sister won’t experience the burdens that he felt when his wife died six months ago. He is 57.

A third guy has stopped answering his phone. The message machine is now full, so no more contact is possible. As a health care professional, he is aware of the actual impacts of esophageal cancer in his body. He feels the pain of the procedures he has undergone. But he feels even more pain about the fact that nobody has overridden his strenuous objections and traveled the three hours to see him as he recovers from his surgery in another city. His attachment to emotional self sufficiency adds to his suffering.

And a fourth has penned more brain cancer jokes than anyone wants to hear, and is proud to have left the hospital between tests after his initial diagnosis to get in his 8 mile training run. He also won his age bracket in a half marathon race a week or two later, and qualified to run in the 2012 Boston Marathon. He’s 30! The doctor told him he was the healthiest cancer patient he’d treated. My friend equated that to being complimented for being the cutest ugly person around. You can see his approach.

As witness to all of these men, what do I find about strength in the face of pain and loss? I am grateful that none of them is much like John Wayne, though the one who is hard to reach has a bit of that going on. Each is flowing in his own way with the story that has been presented to him, not embracing the rigid definition of strength we would ascribe to John Wayne. (I wonder how John Wayne reacted to the stomach cancer that killed him. His son reported that he converted to Catholicism just before his death … .) Each has acknowledged what is happening, and each is dealing with how they are affected. My story of the John Wayne archetype (not the real man, mind you, as I wouldn’t want to hold him to that standard) is that he wouldn’t acknowledge any impact of the disease. In fact, the archetype wouldn’t have undergone the surgery to remove an intestinal blockage that the real John Wayne underwent because “John Wayne” never would have acknowledged the pain.

How can the denial of true experience, whether it is pain, fear, love, ecstasy or confusion, be thought of as the definition of strength? How do we go along with this definition? And don’t think we don’t. Virtually every man I see in therapy makes some apology for shedding a tear, having a feeling, not living up to the iron-faced standard. Even my young friend with brain cancer apologized for “crying like a little girl” when scores of us who care about him gathered for a fundraiser and raised money to start to support his treatment needs. His few tears would hardly describe what my daughter can produce for a minor hurt. How is a man supposed to react when well over a hundred people gather to acknowledge his impact on them—and to show their love, caring and respect at a time of need? When is it okay to be affected by that love, let alone the fear of the cancer that precipitated this display of caring?

After telling him these stories, Rupesh and I suggested to one another components of a new definition of masculine strength. My favorite is that strength is allowing for authentic experience and not being broken by it. Many have acknowledged the role of suppleness rather than rigidity as a component of strength.

Strength also can hold the uncertainty of life rather than prescribing some story of “how things are” or some philosophical thinking to cover the truly unknown. Just ask my friends with cancer about accepting uncertainty. One quipped in a Facebook post, “so many tests, appointments and decisions to still make, and it’ll be weeks [before we have enough information to decide]. I’d say the suspense is killing me, but if something’s killing me, that’s probably not it.”

And strength involves claiming our gifts—not from some grandiose place which hides vulnerability, but from a place of common ground, from a place that acknowledges that we all have gifts, and that denying them is no way to be our best in the world.

As I was thinking about all of this, I ran across an article by psychologist-researcher Dan Siegel about the importance of “integration” as a determinant of healthy functioning in the world. He proposes that integration is described as flexibility, adaptability, coherence, energy and solidity.  Something in this sounds a lot like strength to me.

Now, a year later, some things have changed. The greatest pancreatic cancer therapist of all time didn’t make it through the pain after all. Rupesh and I were with him the night he mercifully died at Christopher House after pain transformed him and robbed him of his loving spirit.

My friend on hospice care also transitioned on. He died February 13 as I was flying back from a ski trip. I had been with him a week before and we had said our loving goodbyes. His transition was painful, but the duration of the pain was minimal, and he let go on his own terms.

The friend who was incommunicado did re-establish communication. I heard a lot about his months of having to sleep sitting up, and battles with demons during recovery. This weekend he called to tell me that he had met a woman 15 years his junior and was trying to take it slow with her. This was apparently new ground for both of them. They have discussed the relationship and sex and many things. He hasn’t told her about the cancer yet.

And my young brain cancer friend still plans to run in the Boston Marathon. He got a mohawk haircut last week to display his question marked shaped scar more prominently. The doctors are pleased that he is one of the 12% who looks like he could survive this disease. He is not unscathed however. The day he arrived back from his out-of-town surgery and recovery process, his wife and high school sweetheart left him. I think he has learned something since then about crying like a baby as he rebuilds his life as a single dad and primary parent to his daughter.

And Rupesh, my dear friend on this journey? This morning he had a bone marrow test as doctors try to figure out what explains the dangerously high fever and pains that have kept him in the hospital for the last week. They are using words like leukemia, lymphoma and “hopefully just a virus.” He is 35.
Read Steve Milan’s poem on denial in the face of death: I Will Not Die

Read more on Cancer on The Good Life.

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