It is not difficult to understand that a diagnosis of cancer – in my case, pancreatic – might produce an existential crisis or, at least, a renewed look at what you have supposed these many years is the meaning of your life, and of the choices you have made.
This struck me with force last week when one of my physicians suggested I take an antidepressant.
The doctor's idea was not without cause. It's not going too far to say that for several days I had found myself mired in a slough of despond, trying to wade through a bunch of negative thoughts that bubbled up unbidden.
The worst was the notion of my unprovable belief that the chemotherapy is not working. So what is the point, thought I, of struggling through it. I also spent some time wondering such things as how incapacitated I might become if/when the disease progresses and I tried out various scenarios of how I would die and...
Well, you get the idea.
The doctor recommended sertaline, generic Zoloft, that he said would help lift the evident depression I was experiencing. I told him I'd do some homework, think about it and get back to him.
It is not an easy drug. As all the reputable medical websites explain, it is used to treat depression, obsessive-compulsive disorder, panic disorder, anxiety disorders, post-traumatic stress disorder (PTSD), and premenstrual dysphoric disorder (PMDD).
The many potential side effects cannot be dismissed without serious consideration:
⚫ Skin rash or hives (with or without fever or joint pain); difficulty breathing; swelling of your face, lips, tongue, or throat require emergency attention.
⚫ Such symptoms as anxiety, panic attacks, trouble sleeping, or if you feel impulsive, irritable, agitated, hostile, aggressive, restless, hyperactive (mentally or physically), more depressed, or have thoughts about suicide or hurting yourself should be reported to one's physician right away.
⚫ Not to mention agitation, hallucinations, fever, sweating, shivering, fast heart rate, muscle stiffness, twitching, loss of coordination, nausea, vomiting, or diarrhea.
There are worse. I will spare you.
The thing about moods, I have noticed in my going-on eight decades, is that they change. Sometimes for obvious reasons, sometimes not so clear.
Mood is closely related to happiness or lack thereof and there have been a lot of books and magazine articles in the past few years about how to achieve happiness. My point of view has always been that one cannot know happiness and probably not even just a buoyant mood without having experienced negative feelings.
Happiness is not a goal in my world, it is a byproduct. The feeling arises when I've been doing something pleasurable or fulfilling or achieved something I have worked hard for.
Happiness cannot be forced any more than depression can be. To me, they are opposite sides of the same coin and I have often welcomed unhappiness or depression or melancholy because those feelings are as crucial to understanding one's self and one's world as discovering what gives you pleasure, i.e. happiness or contentment.
And so I do not want a false or drugged happiness. Especially with the possibility of those side effects; I already live with the same or similar ones from the chemotherapy.
For many years before I was confronted six months ago with the reality of an immanent death sentence, I have always thought – and still do - that I want to be lucid when I die and not in pain. I want to experience the process with as much attention and clarity as possible - the last great adventure of earthly life.
Only half joking, my plan had been to live as long as my great Aunt Edith did (89) or her sister, my grandmother, 92. That's probably not a good bet now. But that doesn't change what I have always intended in the waning years of my life, particularly, the final weeks and months:
I want to feel all the emotions that go with the winding down, that go with knowing that death is no longer theoretical. I want to watch myself make peace – if that is what happens, or not - with existence as I experienced it, with its ending and with the single event that equalizes us all.
No matter how it feels to go through that final phase of life, I want to be certain they are my feelings and not imposed by a drug.