When I became a doctor 40 years ago, a diagnosis of metastatic cancer - cancer that has spread from its original site - was usually a death sentence, rapidly executed. Recent progress in treatment means that sentence is often delayed. For such patients, the existential problem of what gives life meaning and purpose acquires a real and painful immediacy: What matters in life? How should I spend what little time I have left?
In our increasingly confessional age, it’s not surprising that a genre of books has emerged by authors with a future made uncertain by cancer. Some of these memoirs are mainly stories of hope, of fighting crowned with triumph. But in recent years, a spate of books have come forth that begin and end with the author’s death. The most outstanding example to date is Paul Kalanithi’s “When Breath Becomes Air.” Now we have “The Unwinding of the Miracle,” by Julie Yip-Williams.
Yip-Williams died of metastatic colon cancer at age 42 in March 2018, five years after the diagnosis. Her posthumously published book “The Unwinding of the Miracle” is essentially the blog she kept during those five years, ending with her death.
Yip-Williams was a refugee from Vietnam, one of the boat people who came to the United States a child. She interweaves the story of her cancer with that of her family and early life. Only when Yip-Williams was in her 20s did her mother confess to her that her parents had - at her grandmother’s insistence - tried to have her poisoned after birth, as she was born with congenital cataracts. A blind girl in traditional Vietnamese society had a dismal future. The herbalist they went to, however, refused the request. Once in the United States, Yip-Williams’ vision was partially restored by cataract surgery, and she eventually graduated from Harvard Law School.
There is, therefore, a bitter irony to the story. Yip-Williams’ life is a shining example of the American Dream - of hard work and determination against impossible odds being rewarded with affluence and success. She survives attempted infanticide by her own parents and a month’s perilous boat journey to Hong Kong, and despite her fears as a teenager that her poor vision will make her an outcast, she becomes a successful lawyer, meets and marries the man of her dreams and has two children. Then, at age 37, she falls ill with metastatic cancer.
Yip-Williams writes with a savage honesty about the strains her illness and treatment imposed on her children and husband. She writes movingly of how she was torn by the wish to abandon the fight and find peace in accepting her death, and the feeling that this would be betraying her family. “Is it more courageous to continue or to stop?” she asks “Is it more loving to leave or to stay?”
She clearly found no simple answer to this question, despite her contempt for the”syrupy optimism” of one of her oncologists, the “rah-rah-rah nonsense spewed by cancer patients” and “the asinine assertion that there is always hope.” The problem in the United States is compounded by the endless variety of chemotherapy drugs that are available, like all the varieties of toothbrushes and pasta sauces at the supermarket. She tries just about every option possible - drugs with strange, magical names, which in her case are full of false promise. Yip-Williams even tries experimental drugs that seem to work only in fruit flies. “Clinical trials” she bitterly concludes, are “acts of desperation made barely palatable by a thin veneer of science performed on mice.”
ARTICLE CONTINUES BELOW ADVERTISEMENT
Her writing has moments of wry wit: “You fall in and out of love with doctors. You may even be tempted to cheat on your oncologist, have flings with other major hospitals.” Near the end, she transfers to a different oncologist whose more paternalistic and prescriptive approach she finds more helpful that the predecessor who tended to put the burden of choice on her.
This is not an easy book to read - not just because of the sad and inevitable conclusion, but also because it is difficult to write about the conclusions to be drawn from one’s impending death without sounding banal.
“Live, friends. Just live,” she advises us. “Travel. Get some stamps in those passports.” The impressively raw honesty of her howls of protest and pain, and her admission of her occasional failures as a wife and mother, are let down by the rather trite reflections elsewhere in the book on love and finding meaning in her suffering. The book is often repetitive and at times sounds too self-regarding. It desperately needs editing but, as the author’s health declines, this obviously becomes impossible. Once dead, respect for the deceased - in accordance with the age-old principle of de mortuis nisi sed bonum (of the dead, speak nothing but good) - lends the manuscript a degree of sanctity. This is a shame.
The story of Yip-Williams’ early childhood is remarkable. The book contains many powerful and perceptive passages that vividly convey the via dolorosa of surgery, radiation and chemotherapy in the American health-care system, with its agonies of choice and false hope, punctuated by periods of happiness and despair, while trying to lead an outwardly normal life and raise two young children.
“I wanted to face my death with honesty,” Yip-Williams tells us “with eyes wide open, with understanding and courage, even amid the fear, and, I hoped, with some newly gained wisdom.” She finally approaches death consoled by her conviction in an afterlife and tells us that, “in accepting my death, I have learned to live more fully.”
And yet the book shows how difficult this was, and how, as with most of us, it was impossible for her to escape completely from the blessing and curse of hope.