Death in the Garden - by Katerina Cosgrove
ISLAND | ISSUE 159Accustom yourself to the belief that death is nothing to us. For all good and evil lie in sensation, whereas death is the absence of sensation. Death, therefore, the most awful of evils, is nothing to us, seeing that, when we are, death is not come, and, when death is come, we are not.
- Epicurus
Why should I think I’m so special? Why shouldn’t I be the one to die this time, when there are so many kids dying, every day?
- Annette Livas, 1965 – 2010
William Stott, Hide and Seek in the Garden of Epicurus, Leontium and Ternissa
I went for my six-monthly skin cancer check at the end of July. It was drizzling but not cold; here in Queensland winter rests lightly. I sat outside to wait rather than be subjected to the shrill litany of a popular radio station and the Arctic air-con favoured by the receptionist. I go every time, even though I meticulously scan my own body fortnightly, weekly, daily, double-checking any suspicious freckle or bump or sunspot with my husband if I’m unsure. Sometimes they’re tiny as a pinprick, uniform and round and a benign pinkish colour, and he laughs at me. Going to the specialist, though, is a ritual I have to perform in order to be able to sleep at night. So I do, and each time I’m freshly surprised at how little time it takes, how the gentle sweep of my chilled, naked body, my orifices, my shy scalp hidden under my hair lasts all of fifteen minutes.
On an October day in Sydney in 2014, fragrant with calla lilies on suburban streets, my oncologist gave me the good news. I’d passed the five-year mark and didn’t need to see him again unless there was a problem.
“On an October day in Sydney in 2014, fragrant with calla lilies on suburban streets, my oncologist gave me the good news. I’d passed the five-year mark and didn’t need to see him again unless there was a problem.”
He gave me all the expected advice: keep out of the harsh Australian sun, and wear zinc oxide sunscreen, long-sleeved clothes, sunglasses and a wide-brimmed hat. He scolded me in that mild way of his, as he did every year, for being overly tanned. We shook hands. I remembered the sympathetic expression he wore when I first met him, when I came into hospital for a wide re-excision of my right ribcage and a biopsy of the sentinel lymph nodes under my arm. I remembered his enormous, square surgeon’s fingers, reddish at the tips. And how, a year to the month after my operation, when I came for yet another follow-up and told him my older sister had just died of melanoma – the same cancer – his eyes, for a moment, glittered with tears.
Annette and I were born on the same day in November, eight years apart. I was her birthday present, along with the lazy drift of jacaranda petals carpeting our sunny, suburban nature strip. She gave me my second name, Vanessa. She rocked me to sleep, singing a soft lullaby in a made-up language only she could understand. She biked me to preschool in the mornings, waited for me at the gate in the afternoons. When I left home at eighteen, she would visit my falling-apart, inner-city terrace and attack the bathroom and kitchen with steel wool, white vinegar and bleach. Once, getting ready to mop, she tried to lift the shower mat but it was stuck to the tiles with months of accumulated filth.
We were both diagnosed with melanoma: hers in 2007, pale and shapeless, nested deep in her cornea; mine in 2009, shiny and round and black as a Kalamata olive, skimming the surface of my skin under my right breast. I survived and she died.
“We were both diagnosed with melanoma: hers in 2007, pale and shapeless, nested deep in her cornea; mine in 2009, shiny and round and black as a Kalamata olive, skimming the surface of my skin under my right breast. I survived and she died.”
My sister and I shared more than our terminal pain: difficult childhoods; early marriages at nineteen that went bust (in my case) and continued until death do us part (in hers); a genetic chronic illness we both managed with drugs and diet. We learned to negotiate a fundamentalist Greek Orthodox mother, rigid and tenderly serious, and an agnostic Australian father who made everything into a joke. Yet we were forced even closer by something else: our shared cancer diagnosis and facing death together.
I know that if I were to go back to see my oncologist this year, or the next, or in another decade, he and his well-meaning colleagues would pump me full of poisons if they couldn’t cut out enough of the tumours, even though we know melanoma doesn’t respond to these treatments once it’s metastasised. There is no known survival rate for metastatic melanoma beyond five years. The global incidence of melanoma has risen in a steep, jagged wave over the last thirty years, and nothing seems to stem the tide. But what else to do? Doctors and surgeons are not trained to give up easily. They will recommend a treatment even though it will do little to prolong life and will turn even the flimsy life that is left into hell.
I saw it happen to Annette. They couldn’t cut out the Stage IV tumours in her liver, lungs, brain and remaining eye; her other eye had been removed in her initial diagnosis. There were just too many of them. Instead, they tried to shrink them with chemotherapy drugs. I won’t bore you with their various names, and the tinkering with dosages and types, and whether she had the BRAF gene mutation and could get into a clinical trial (she didn’t), and why they couldn’t use immunotherapy or targeted molecular therapy. The chemo drugs made her nauseous, bloated, sleepless and agonised. She suffered from mouth sores, her scalp burned, she vomited, she was incontinent and had no appetite except for the sips of cold milk she forced herself to swallow.
Yet these drugs did actually shrink the tumours for a few weeks. She allowed herself a small flicker of hope. She made plans, attended a wedding. She fantasised about seeing Greece – our mother’s homeland – for the first time. Then they grew back, larger and faster than before, as if the drugs had given them new power, while her body and spirit weakened, unable to fight. She needed blood transfusions every few days. She couldn’t make it to the toilet on her own. She started hallucinating.
I knelt in front of her as she lay on my hard daybed the week before she died. She, who knew, even if she wouldn’t admit it, that she was dying, had made the long trip to the northern beaches from her home in the western suburbs of Sydney, to see my home for the last time. To see the angophoras, shedding their rust-coloured bark in spectacular sheets, to smell the lemon-scented tea-trees, to watch rainbow lorikeets and king parrots visit my deck. To observe the way light shivered through the leaves and to feel it wash over her when the sun set. Her husband and three children stood around her, unable to speak, not sure what to do with their eyes and hands. They looked everywhere except at her face. I could look nowhere else. Her remaining pupil was huge from morphine. Her hair was still dark, thick and glossy, a black cockatoo’s wing. Her skin poreless, translucent.
“Her husband and three children stood around her, unable to speak, not sure what to do with their eyes and hands. They looked everywhere except at her face. I could look nowhere else. Her remaining pupil was huge from morphine. Her hair was still dark, thick and glossy, a black cockatoo’s wing. Her skin poreless, translucent.”
She dozed on the daybed, drifting in and out of lucidity. Once she gave a high-pitched cry that made us rush to her.
She was scanning the room, looking up at the ceiling, the cushions, down at the rug, not at us.
‘I’m not scared of dying. I just wish …’ She stopped and held her breath. I could see her throat working. ‘I bought Jordan a new lunchbox for next term, and I just know I won’t be here to see him use it.’
It was then, for the first time, I saw her break down. My sister, whose eye was removed a few days after Christmas in 2007, whose cancer then metastasised in early 2010, had not cried in front of us until that moment.
But she stopped herself within moments. She gripped her husband’s hand, joking that she could now fit into a pair of expensive skinny jeans she’d never been able to squeeze into before.
‘Now, of all things’, she said. ‘Now that I don’t even care!’
The chemo drugs had made her seem youthful, dewy. Or maybe it was the steroids. At forty-four she had no wrinkles. Her cheeks were plump and pink. She was beautiful, even with tears drying on her face. But she was dying a slower, more painful death.
Epicurus wrote of a pleasurable death. The ancient Aegean philosopher, who founded a school of thought championing the pursuit of hedonism, looked forward to a death of calm and stillness, the blissful oneness of a pure meditative state. This is the sort of happy death I want.
“Epicurus wrote of a pleasurable death. The ancient Aegean philosopher, who founded a school of thought championing the pursuit of hedonism, looked forward to a death of calm and stillness, the blissful oneness of a pure meditative state. This is the sort of happy death I want.”
I want to be prepared for it; I want to understand it and welcome it with minimal resistance. My sister denied she was dying, even on the day, one week later, before she died. She waited for a cloud-bursting Greek Orthodox miracle at the eleventh hour. Even as she was wheeled into the ambulance to the hospice, she brushed her hair, put on some lipstick, smiled. She’d had her hair coloured and her eyebrows waxed the week before. She told me she didn’t want her children being ashamed of her in an open casket.
Just before the paramedics closed the ambulance doors she turned to her family and said, ‘Don’t worry, I just need a rest. I’ll be back home soon.’
I think of Epicurus in The Garden (o κῆπος) – the community he established in Athens, after being hounded from his birthplace of Samos and from Lesbos. He and his followers, many of them women, reclining on thyme and chamomile lawns, eating simple meals of wild herbs and goat’s cheese and grapes. ‘The art of living well and dying well are one,’ he said.
I know a little more now than I did when my sister died, when I was reeling with loss and senseless with shock. I know that I don’t necessarily need to have a painful, confusing terminal illness or death. There are other ways to achieve more freedom and tranquility at the end of my life.
*
In 2014, research carried out at the University of East Anglia and published in the Journal of Biological Chemistry reported that the main psychoactive phytochemical in cannabis (tetrahydrocannabinol or THC) slowed the growth of cancerous cells in lab mice. For the first time, scientists were able to identify two specific receptors responsible for the disease-fighting effects. In 2015 an in vitro and in vivo study published in the Journal of Investigative Dermatology found that treatment with THC and cannabidiol (CBD, the non-psychoactive component) decreased melanoma cells. These isolated compounds also decreased tumours in breast, prostate, lung, pancreatic, colorectal, brain and bladder cancer, as well as leukaemia. For those patients who don’t want the THC ‘high’, CBD oil by itself has been shown to alleviate the side-effects of chemotherapy and to regulate the signalling pathways involved in cell proliferation, thus inhibiting progression of the cancer.
There are also anecdotal reports. Story after story claiming remissions of Stage IV melanoma with CBD and THC oil. People living longer and more enriching lives. The oil shrinking the metastatic tumours, boosting general immunity and helping with appetite, sleep, mood and wellbeing.
I wish I had known this when Annette was dying in Canterbury Hospital. Instead, when the call came, my husband and daughter and I were at Sydney’s Circular Quay meeting friends from Melbourne. My mother, wailing in Greek. I couldn’t understand what she was saying. She howled. The wavering tones of her voice went up, down, up, down with her wrenching sobs. I handed the phone to my husband.
‘She’s dying, Niko, she’s dying.’ My mother’s grief was too much to bear. Not only did it terrify me, it made me feel like I couldn’t breathe. I could hear her through the phone. ‘My little girl is dying.’
When we got to the hospital, Annette was dead. There was no sign of the pain and struggle my mother and father and Annette’s husband and children had witnessed. She had been thrashing in the bed, trying to breathe, fighting to speak. She’d asked her eldest son to close the blinds, whispering to him that the light hurt her eyes. When he hesitated, she screamed.
Now, she looked asleep. My mother had tied her jaw shut with a white linen cloth, the way she’d been taught in her village, so that Annette’s mouth wouldn’t hang open. My brother-in-law tore it off, unable to bear her face being obscured by the thick cloth. But it had worked. Annette’s mouth was not slack or dead-looking. It was pursed lightly, as if she were just about to tell us everything we had ever wanted to know.
The hospice nurses laid her out under the thin blue cotton bedspread, her hands clasped on her chest. My mother lit a votive oil lamp on a shelf above her head, which cast a tremulous light onto a Byzantine icon and onto her face. Then they left me.
What struck me most was the quality of the silence around her – even coming from her. As the wick bobbed up and down in olive oil, the skin of her face, neck and hands were bathed in honeyed strands of light, shifting like the sunlight through Avalon’s angophora leaves.
“What struck me most was the quality of the silence around her – even coming from her. As the wick bobbed up and down in olive oil, the skin of her face, neck and hands were bathed in honeyed strands of light, shifting like the sunlight through Avalon’s angophora leaves.”
All the signs of strain and worry were gone. All the disappointments and expectations we accumulate from these lives of ours were smoothed away in that light, that stillness. She was more beautiful than she’d ever been. I wanted to pull aside the bedspread and get into bed with her; to soak up some of that serenity by osmosis. I wished that the process of her dying, just a half-hour before, had been as peaceful as this moment, with the oil lamp burning in front of the icon. I too want to know that peace in death.
*
Epicurus died in 270 BC at the age of seventy-two, slowly and in agony, from stones blocking his urinary tract. According to a (perhaps apocryphal) letter written by Epicurus to one of his students, Idomeneus of Lampsacus, he wrote ‘on a happy day to me, which is also the last day of my life. For I have been attacked by a painful inability to urinate … but the cheerfulness of my mind, which comes from the recollection of all my philosophical contemplation, counterbalances all these afflictions.’
I see myself in two scenarios, if my cancer comes back. In and out of hospital, dying by inches, burdened by the horror of medical procedures and the anxiety of family and friends. Or treating myself at home. I can’t see myself putting my life into the hands of the medical establishment. Not this time.
My journey has been hard and rough; towards health, even vibrancy and vigour on some days. This practice of moment-by-moment gratitude for life, love and family have helped to heal me. Moving away from the city. Learning to worry less. Eating. Drinking. Sleeping. Walking. Remembering Annette whenever I get too caught up, when I start identifying with the thousand-and-one things I know are ephemeral. This is my personal path to Epicurus’s ataraxia: the slow absence of fear that comes from a tacit acceptance of my inevitable death.
‘Here our highest good is pleasure,’ he said. Pleasure, yes. I take intense pleasure in the sunlight slanting through the blinds, silvering the swamp banksias at my bedroom window; my teenage daughter’s petal-soft cheek under my palm. Our bush garden with its kaffir limes, Meyer lemons and figs. The birds and kangaroos and native bees who visit each morning. Thrilling wonder at the tiny things, the pearl beads of in-breath and out-breath which make up each day. The steady unscrolling of my years, still alive. ▼
This article appeared in Island 159 in 2020. Order a print issue here.
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