Uncertainties

The Last Walk (Part 5)

            Cancer complicates life.  Daily activities take longer.  Every visit to the bath presents danger of falling.  The caregiver wants to intervene, to protect against injury.  But the patient needs to do as much for herself as she can, to maintain strength, balance, mental agility, etc.  In addition to such little complications, there are some big ones.  We have to adjust on the fly.

            For example, on September 10 I drove Karen to visit Tim and Tia, our son and daughter-in-law, who live in Kennewick.  Karen had been looking forward to this trip for weeks.  The next day, Sunday, Karen felt sick, with flu symptoms.  She didn’t want to expose Jakobi, our grandson, so she asked Tim to drive her home. 

            We suspect Karen’s symptoms came from having a flu shot.  It’s wise, of course for her to have a flu shot; influenza can be fatal to people with weakened immune systems.  The down side of inoculation is that people often get mild flu symptoms—but for cancer patients, mild symptoms aren’t so mild. 

Karen called me when she and Tim set out.  I drove east and met Tim and Karen in the tiny town of Rufus, and from there I brought her home.  So the planned week with Tim and Tia amounted to one night.  And for Karen the drive home was thoroughly unpleasant.

            Another big adjustment: Janie, my sister-in-law, took Karen for her third chemo treatment yesterday.  For a number of reasons Dr. G judged her too weak to receive it.  Chemotherapy hits the body hard; the hope is that in doing so it hits the cancer harder.  Given Karen’s lethargy, mental confusion, dehydration, and other factors, Dr. G said he would not administer the drugs.  She was given I.V. hydration, which helped perk her up, and Dr. G recommended that we ask the home health service to move her to palliative care.

            Palliative care, I’ve learned, is a more intense version of home health care.  (As I type this, we’re waiting for the nurse’s visit.)  According to Dr. G, patients under palliative care often improve.  He’s counting on that, hoping that Karen will be stronger and more alert in two weeks so she can get chemo.

            Now when I first heard “palliative care or maybe hospice care” (Janie’s phrase on the phone when she told me) my mind latched onto the word “hospice,” and I assumed the doctor’s advice meant Karen and Phil’s last walk would soon end.  A later conversation with a home health care supervisor reassured me.  It is not unreasonable to expect good results from palliative care.  If Karen gets stronger, she may have more chemotherapy.  If she gets chemotherapy, it may significantly extend her life.

            So now we live in an uncertain space.  Will Karen be ready for chemo in two weeks?  Is the chemo actually working against the cancer?  Tim and Tia plan to come to Newberg soon; will Karen be alert to enjoy their visit?

            Cancer brings long term uncertainties too, some of which we can prepare for—reviewing and revising legal documents, buying a burial niche, arranging for cremation, etc.  There’s a lot of detail work to get ready to die!  Yet every conversation is peppered with “if” or “someday” or “eventually.”  So much we don’t know; we don’t even know that Karen will die before me, and the documents must reflect that possibility.

            When you think about it, cancer only reveals something that is true of every life.  We all live in uncertain space.  The vibrantly healthy college students in my classroom eagerly make plans for the weekend, the holidays, or their careers after graduation.  God bless them—I hope their plans bear fruit as they expect.  But the truth is that we do not know what tomorrow will bring.  Three weeks, three months, or three years: cancer makes our uncertain space plain to Karen and me.  What we can be sure of is how we face the uncertainty.  I will love Karen to the end, no matter what.  Because of the gospel of Christ, we hope for resurrection, no matter what.

Promises

Discrete Events and Narrative Lives (Part 4)

            In part three of this series, I promised to return to the problem of personal identity “next week.”  That was three weeks ago.  The accidents of life get in the way of our plans; instead of writing about narrative the last two weeks, I added essays to The Last Walk.  Only now do I return to my topic: narrative, personal identity, and morality.

            Notice how this episode illustrates, in a minor way, the complexity of the questions we are considering.  “I” announced my “intention” of accomplishing some “action” (publishing a blog post, in this case).  Today I offer an explanation as to why I didn’t do what I announced. 

Philosophers ponder mysteries in that sequence: What constitutes a person?  What are intentional states (of anything, but especially of persons)?  What distinguishes an action of a person from other events in the world?  For which actions or failures to act should persons supply explanations or apologies?

            There’s no way I’m going to sort out all these questions in a single essay.   Philosophy of Mind is a jungle of interrelated questions.  I just want to tame a little corner of the jungle.

            The skeptical worry, remember, is the thought that we should regard our personal narratives as fictions.  A number of undeniable facts motivate the skeptical worry.  First, we know that discrete events (such as the outcome of particular at-bats) are largely unaffected by the stories we tell about them (e.g. Allen Average is having a good day batting).  Second, we know that our memories of past events, including events in our personal lives, are often objectively inaccurate.  Third, at best our memories of our lives comprise a tiny minority of the events that make up our past.  Fourth, we know that events can greatly change persons’ character; we say with some measure of truth that so-and-so is not the same person she was at some prior time.  Therefore, the skeptical worry says, we should not put much stock in our personal narratives; perhaps we should think of ourselves as “strong poets” (Richard Rorty’s suggestion) who regularly invent or reinvent ourselves by recasting our stories.

            In spite of all this I will argue for a narrative understanding of personhood.  I think the following claims are all true.  First: a person’s life gains identity by means of narrative.  It is by story that one event connects meaningfully with another; without narrative the events in our lives are just one damn thing after another.  Second: only a narrative personal identity can ground and explain significant moral duties.  Third: human beings are capable of deceiving themselves about almost everything, including their narrative based identity, so it is possible for persons to achieve better or worse understandings of themselves.  Fourth: the true story of any person’s life can only be discerned against the backdrop of a true story of the world in which that person lives.  Against those philosophers who proclaim the death of meta-narrative, I think we need meta-narrative.  (Notice: the so-called death of meta-narrative is usually presented as a story.)  If the great story of Christ is true, I can only rightly understand my story as part of his story.

            As I said, there is no way I can defend all these assertions in one essay.  I will offer a few remarks in support of the second claim, that only a narrative personal identity can ground and explain significant moral duties.

            Consider two episodes from my life.  In 1977 in a marriage ceremony, I promised Karen that I would be a loving and faithful husband for the rest of our lives together.  In 1989, a judge explained to a little boy, Jamie Bolles, that because of the paper she was signing he would be James Keith Smith, and he would be a “forever” part of our family.  At the time of the judge’s decree, Karen and I promised to James that we would love him and care for him no matter what.  Considered dispassionately, these are not unusual events.  Thousands of adoptions are finalized every year in this country, and marriages are even more frequent.

            Promises are central to marriages and adoptions.  Like me, in many cases the people who make such promises live for many years after making the promise.  Life happens.  People change.  Surely there is some sense of the phrase in which it is true to say: I am not that person anymore.  Yet I think—and I think most people would agree—that the promise made then has moral import now.  There is a sense in which the promise commands me; it lays obligation on me.  The promise limits my life, because I made it.  I, a person living decades after the promise, am morally constrained by that promise because I am the person who made it.

            I am not saying that marriage promises or adoption promises create iron laws with no exceptions.  I know people who divorced.  I know of disrupted adoptions.  I have no interest in condemning such people or adding to their pain.  There are situations of tragic moral choice.  But I point out that one reason such tragedies are tragic is that persons think they must break promises.  They feel they must, morally must, do one thing, and yet they feel they must not do that thing.  Promises do not simply lose their moral force simply because time has passed and I am a new person.

            My argument is simple.  We have a pretty clear moral intuition that marriage promises and adoption promises create obligations for those who make them.  The only way this intuition can be right is if there is such a thing as personal identity over time.  That is: it is right to do this thing now, because I promised I would—even if the promise was made decades ago by a very different “me.”  The best way to describe personal identity is through narrative.  I make sense of my life by the story I live.

Back Home

The Last Walk 4

Romans 12:12: “Be joyful in hope,

patient in affliction, faithful in prayer.”

            Paul’s words present a stiff challenge.  Are Karen and I joyful, patient, faithful?  Hm.  On the last point, many friends have assured us they are praying for Karen and me on our last walk.  Prayer is a facet of human solidarity, and we are grateful for our friends’ prayers.  A week ago I asked friends to pray that Karen could come home.

            Who would have guessed that a kidney stone could be good news?  On Thursday, Dr. B operated on Karen’s right kidney, removing the stone and placing a stent in her ureter.  (Dr. B calls himself the plumbing doctor; he’s an urologist, not to be confused with a nephrologist, the kidney expert.  In Karen’s case, they both are part of a team, of which Dr G, the oncologist, is head.  I’m learning lots of new vocabulary.)

Karen’s body chemistry and mental functioning began improving immediately after surgery.  During a two-hour visit later Thursday, I witnessed her voice strengthening and her mind clearing.  Friday afternoon, when I checked phone messages after class, Jennie, our daughter-in-law, said not to go to the hospital.  My sister-in-law Janie had taken Karen home already.

In the five days since then we’ve been learning to balance pain meds.  If she takes too little, Karen’s pain spikes, especially if she “does” anything—stand up, dress herself, walk a few steps, etc.  Call this Scylla.  On the other hand, if we overdo the meds (or give one too soon after the other) the drugs hammer her cognitive abilities.  That’s Charybdis.  Like Odysseus, we try to navigate between the monster and the whirlpool.  Of course, Karen faces complications that Odysseus could never have imagined.  For example, after kidney surgery patients sometimes experience sudden, uncontrollable bladder function.  That stage has passed, thank God; but we had a series of adventures last Friday night!

Karen was scheduled for a chemo treatment Tuesday, but Dr. G postponed it.  It’s more important to achieve balance on pain meds.  There is clinical evidence that good pain control improves the efficacy of chemotherapy, he says.  Karen is learning to judge her pain state more precisely; learning to take the “break-through” meds before pain increases.  We’re getting better at pain management, so much so that Karen called Tim and Tia (son and daughter-in-law) to confirm her plan to visit them next week.  It’s her decision to make, so I will drive to Kennewick on two successive Saturdays, delivering her on the first and retrieving her the next.  I expect lots of pictures of Jakobi.  Meanwhile, we have had visits from home health care and home health physical therapy.

That’s a lot of prayers answered in only a week.  “…faithful in prayer” sounds like good advice.

Hospital

The Last Walk 3

            I suppose if one had much experience with cancer, as oncology professionals do, one would discern a pattern in the progress of the disease.  Karen’s oncologist, Dr. G, tried to give us a sense of what we could expect.  This was in July.

            First, he said, there is a small chance chemotherapy would completely kill the cancer.  Karen might be cured and live for years.  Much more likely, however, chemo treatments would achieve “control” of the cancer.  In Dr. G’s words, this meant each round of therapy would kill much of the cancer but not eliminate it.  We could expect the disease to return every time.  By a kind of natural selection it would return stronger, more able to resist drugs.  Eventually, even using different anti-cancer drugs in the chemo cocktail, the disease will kill Karen.  “Control” thus means that Karen might live a year or as long as five years.  Perhaps 70% of cases achieve control.

            What Dr. G left unsaid (I’m drawing conclusions on my own here) is that 5% and 70% leaves a quarter of the cases in which chemo has little or no effect.  Without treatment, Dr. G said, the cancer would kill Karen in six months or less.

            The “typical” history of the disease is a generalization from many cases.  Dr. G summarized for us not only from his own experience but the medical literature.  But Karen’s case is not the typical case; it is one particular case.  She and I will go through the ups and downs of this cancer, and it’s not conforming to expectations. 

            I had to take Karen to hospital.  Here’s the story as far as we know it.

            Chemo knocks Karen’s blood chemistry for a loop.  Kills cancer?  We hope so.  It definitely reduces her hemoglobin.  Blood with reduced oxygen carrying capacity produces deep fatigue.  So: cancer à chemo à lowered hemoglobin à fatigue.  She had her first transfusion eighteen days ago.

            Karen also takes medications for pain.  Lots of them; I won’t go into details.  Let’s just say they are powerful.  Pain meds act on her nervous system (duh); combined with the extreme fatigue they interfere with her mental functioning.  She starts a thought or a sentence and can’t finish.  She falls asleep in mid-thought.  So: cancer à pain meds (+ fatigue) à confusion.  After 30 years as a clinical psychologist this frightens Karen.  Most of those years were spent administering neuropsychological tests; she is familiar with the various stages and forms of dementia.  On Sunday, amid tears she feared people using that word about her.  It’s the drugs, I said.  “My brain is structurally sound,” she answered, lucid for a few seconds.

            Then Karen noticed that her left leg was swollen.  That was the last bit of evidence.  I took her to hospital.  Emergency Room staff worried at first about a blood clot.  Testing seemed to show that wasn’t the problem, but her kidney function was off.  They ordered transport to a larger hospital.

            On Monday, at St. Vincent’s she had her second transfusion.  Over the next two days, her fatigue lessened, but only a little.  The hemoglobin problem was solved (temporarily anyway), but pain meds and messed up blood chemistry were still there.  It turns out that chemo sometimes causes certain kidney diseases.  Who knew?  On Tuesday we thought maybe her chemo cocktail would have to be changed.  She’s due for chemotherapy next Tuesday.

            Tests: ultrasound pointed to problems with the right kidney.  They wanted to perform a CT scan “with contrast,” which means injecting a special dye into the patient; this test is top of the line.  But the dye is nasty stuff and dangerous if the patient’s kidneys are working properly.  On Wednesday, an ordinary CT scan, without contrast, revealed a kidney stone. 

Many years ago, my father suffered terribly from kidney stones.  But this stone is good news!  The problem may be correctable without compromising Karen’s chemotherapy.  Surgery is scheduled for Thursday.  Meanwhile, hospital staff has more carefully calibrated her pain meds, and she sleeps more peacefully.  I hope she can come home a day or two after surgery.

            This, and other “Last Walk” posts, are collected, along with many other essays, on my blog: storymeaning.blogspot.com.

           

           

Fictions?

Discrete Events and Narrative Lives (Part 3)

            Last week I introduced the “skeptical worry.”  The skeptical worry builds on undeniable facts about our personal stories.  First, the narratives we tell often deceive us about the likelihood of discrete events in the future—Allen Average’s chance of getting a hit in his next at-bat is unchanged by the fact that he already has three hits today.  Second, the stories we tell about ourselves, including those we tell to ourselves, are very often factually wrong about our past.  We forget things, we fill in the holes of memory with inventions, and we over or underemphasize things according to our narrative goals.  Third, at best our self-stories are comprised of a tiny fraction of the events that made up our lives to this point.  We remember very little of what we did last week, and the distant past is a fog. 

Therefore, the skeptical worry concludes, we ought to regard our self-stories as fictions.  Our narratives are merely stories, which we make up.

I think it is philosophically and morally important that we not regard our self-stories as fictions.  A person’s self-understanding, her identity, is wrapped up in her self-story.  Our narratives tell us who we are and what we ought to become.  Getting self-story right is crucial to living a good life.  I’m going to argue for my position, but before I do so, I will dredge up yet another undeniable fact that seems to support the skeptical worry, and that fact is this: sometimes our lives change in dramatic ways.

A car accident kills a mother, leaving her husband to care for two children.  The other driver in the accident is convicted of driving under the influence; he is sentenced to prison.  A drug-addict wanders into the gospel mission and gets sober.  A middle-aged man visits a casino for the first time and starts gambling compulsively.  Someone receives an unexpected inheritance.  In such stories, people change; sometimes we say, “She isn’t the same person anymore.”  The dramatic change may be sudden, as in the case of a stroke, or gradual, as in the case of a prisoner who changes from an angry twenty-year-old on the day of sentencing to the restrained and wiser forty-five-year-old who is finally released.

We have story-telling devices for describing such changes.  “That was my life, gradually sinking into despair, until I entered therapy.”  “Everything was fine until the recession hit.  We lost our jobs and in ten months we were homeless.”  These story-telling devices make sense of the before-and-after; they show how someone who “isn’t the same person” in one sense is, in another sense, still the same person.

Philosophers theorize about such things.  They ask: What is it that constitutes a person’s identity over time?  In what sense is the old woman the same person as the little girl of seventy years ago?  Is it because the current 75 year-old body has come into being through countless incremental changes of a 5 year-old body?  Is the rule “same body, same person” (provided the earlier body gradually morphed into the later one)?  Or do we need to have some kind of psychological connectedness to the earlier self?  Is the rule “same mind, same person”?  Or should we say “same soul, same person”?

As you might expect, Philosophy of Mind, the branch of philosophy that explores these questions, is complicated.  Students’ eyes sometimes glaze over when exposed to philosophers’ arguments and counter-arguments.  The questions become abstruse.  We need to remind ourselves the matter is important, and it troubles non-philosophers.  To quote Supertramp:

There are times when all the world’s asleep,

The questions run too deep

For such a simple man.

Won’t you please, please tell me what we’ve learned

I know it sounds absurd

But please tell me who I am.

“… tell me who I am” is the plaintive cry of ordinary persons, not only philosophers.  If I don’t know who I am, how can I act responsibly?  And who am I, if not the subject of my story?

Someone might argue that moral agency and/or responsibility hangs on one’s status as a rational being, not on the accidents of one’s history.  The eighteenth century philosopher Immanuel Kant would be a representative voice of this view.  Our moral duty is to obey the categorical imperative, Kant said.  The details of one’s life—one’s family, culture, century, health, and other such—merely create specific situations.  One’s duty as a rational being is to interpret the categorical imperative for each situation.

I suspect there are other philosophers who would agree with Kant’s conclusion—narrative doesn’t matter morally—without accepting his overall philosophy.  Kant was, after all, the quintessential modern philosopher.  Post-modernists reject his basic assumptions.  I think a post-modern philosopher like Richard Rorty would argue that we should regard our deepest moral intuitions as nothing more than accidents (not the product of “Reason” with a capital R).  And yet, Rorty would say, such judgments are our deepest intuitions, so we may as well go forward with them.  Kant thinks we can know our true duty without history.  Rorty thinks there is no “true” duty, because our stories are fictions; nevertheless, our intuitions about duty are all we’ve got.

I don’t believe in autonomous reason.  (One of the chapters in my dissertation is about Kant and what I call “the myth of autonomous reason.”)  I don’t believe in moral duty without history.  Against Rorty, I don’t believe ironic convictions can carry the freight of real moral living.  They don’t answer the cry: “Please tell me who I am.”  

We need to know who we are.  In spite of the reasons behind the skeptical worry, it won’t suffice to regard our stories as fictions.  Next week I will suggest a way forward.

Welcome Russian Readers

What's Going on in Russia?

     In recent weeks Story and Meaning has been visited more often by people in Russia than any other country, including the United States.  Today, the total number of site visits from Russia surpassed 1000.  I've been blogging Story and Meaning for more than four years, so 1000 visits may not seem like much.  Nevertheless, I'm pleased and flattered that people continue to read it.
     Thank you!

Skeptical Worry

Discrete Events and Narrative Lives (Part 2)

            Sabermatricians know that Allen Average’s success in his first three at-bats today says nothing about his chances of success in his next at-bat.  Therefore, they are deeply skeptical about many explicit or implicit narratives we often hear about baseball players:

“Bobby Bewildering has a career .290 average against left-handed pitchers, but for the last week he’s 1 for 14 against them.  His manager will be second-guessed for leaving him in the game to face Lefty Lou in this crucial situation…”

Or:

“Pre-season prognosticators pegged Our Town Heroes as a sub .500 team, but the Heroes are in the thick of the pennant race.  Baseball analysts don’t know what to say about the Heroes’ success.  More and more of them are adopting outfielder Cam Comstock’s notion that knowing when to hit is as important as knowing how to hit.”

Now, it may be true that Bobby Bewildering has hit lefties poorly for a week.  It may be true that the Heroes have been clustering their hits and producing more runs than one would otherwise expect—and they may have been doing this for three or four months.  These are facts about the past.  But these facts do not imply that Mr. Bewildering will continue to struggle against lefties or that Our Town Heroes are likely to continue clustering their hits. 

As I say, then, Sabermatricians are skeptical of narratives.  They do not believe in “grit” or “team chemistry” or “momentum.”  They do believe in luck, in the sense that an inferior team can beat a better team on any particular day.  After all, terrible teams win a third of their games and truly great teams still lose a third of the time.  In the course of a long season, the eventual champion team will have lost games to the worst team in the league.  At some point in the season, a really bad team will win four or five in a row; that does not mean they have “turned their season around.”

Many Sabermatricians would agree: When it comes to predicting the future, narrative doesn’t matter; talent does. 

There is an obvious limitation or exception to that slogan, well known to Sabermatricians.  Talent changes over time.  Young players tend to get better as their bodies mature and they practice their skills.  Old players’ talent tends to regress; inevitably a time will come when they are no longer able to play at an elite level.  It is a player or team’s true talent that determines the probability of success in any discrete event, but talent does increase and decrease over time.

I muse about baseball and discrete events not merely to indulge my inner baseball fan.  The Sabermatricians’ skepticism about narratives connects with questions in philosophy.  It turns out that narrative is a contentious and mysterious thing.  Here’s a quote from Louis Mink that points to some of the issues:

Stories are not lived but told.  Life has no beginnings, middles, or ends; there are meetings, but the start of an affair belongs to the story we tell ourselves later, and there are partings, but final partings only in the story. … Only in the story is it America which Columbus discovers and only in the story is the kingdom lost for want of a nail. (1970)

I said in part 1 of this essay that we live narratives.  Of course, I also pointed out that in doing so we often deceive ourselves.  The probability of discreet events seems immune to the stories we tell ourselves.  Along comes Mink, saying that we do not live stories; rather, we tell stories.  Perhaps the greatest self-deception is that we explain ourselves to ourselves by telling stories about ourselves.

Are the stories we tell about ourselves accurate?  Plenty of psychological research answers: Not very.

When people tells stories about the past, including stories about their own past, they tend to emphasize some parts and neglect other parts.  In extreme cases some people may repress painful memories or invent episodes wholesale.  Much more often, the storyteller simply fills in the parts he doesn’t remember with plausible details.  He may dwell on the humorous or scary or disgusting elements of the story because these parts fit the point of the story.  Over time, when storytellers tell their story repeatedly, the story gets standardized; the teller uses almost exactly the same words over and over.  This doesn’t mean the story is accurate; it only means it has been reduced to a formula.

A worry begins to emerge.  Call it the skeptical worry, parallel to the Sabermatricians skepticism about baseball narratives.  “Look,” the worry says, “People don’t remember their past accurately.  Most of us have only fragmentary memories of any part of our lives.  It could not be otherwise.  Thousands of seemingly important things happened to us when we were x years old, but we don’t remember most of them.  And psychological research shows that those we do remember have probably been warped by the ways we have told them.  Therefore, the stories we tell about ourselves ought to be regarded as fictions.”

We must admit the skeptical worry gets lots of things right.  Our memories fail us.  The stories we tell ourselves can mislead us about the future, and they may misrepresent the past.  Nevertheless, I reject the skeptical worry.  I will begin explaining why I reject it next week.