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Of cancer, quitting

For John and Elizabeth Edwards, staying in the presidential race despite recurrence of her cancer makes sense on philosophical and practical levels and teaches a lesson to all of us.

By LODOVICO BALDUCCI Special to the Times
Published April 1, 2007


I'm no fan of John Edwards, but as a cancer doctor, I do admire his and his spouse's candor in talking so publicly about their private lives and their decision to continue his presidential campaign. The news offers a unique opportunity to dispel dangerous myths about cancer and about death. As a medical oncologist who has ministered to thousands of terminally ill people, I know that the process of dying may be treasured as much as any other human experience. One's life becomes meaningful only when one learns to come to terms with death. We are all going to die. The only way to defeat death is to co-opt it as we still live.

But before anyone should presume to advise the Edwardses about managing cancer in the family, there are two basic orders of business to keep in mind. First, Elizabeth Edwards may not die of cancer any time soon; indeed, she may not die of cancer at all. It is not farfetched to assume that she may survive two presidential terms, able to exercise the functions of a first lady. Second, the proximity of death may represent the best opportunity to celebrate life by focusing on the goals one considers most important and rewarding.

Mrs. Edwards may not die any time soon. As far as we know her cancer involves only the bones, and those patients may live several years. I have seen patients with breast cancers metastatic to the bones surviving 20 years and longer. Some of them would have died of another preventable cause, such as a heart attack or a stroke had I not been able to force the hand of a vascular surgeon reluctant to operate on the heart or the carotid of a person with metastatic cancer!

As long as it does not involve more vital organs such as the liver, the lung, or the brain, Mrs. Edwards' cancer may not represent an impediment to an effective political campaign more serious than the multiple sclerosis of Mitt Romney's wife, and certainly not as serious as FDR's polio. Considering the rapid progress in the management of breast cancer, it is not overly optimistic to expect that each year of life gain may produce several additional years, as a result of new discoveries.

Should Mrs. Edwards die of cancer, I can't think of any better way of facing death than pursuing one of hers and her spouse's lifelong dreams. In my experience the patients with the most memorable deaths have been those able to uphold a vision of life that went beyond the temporal limits of their own existence: those who enjoyed planting trees and flowers that they knew they would never see grow; those who realize that the only certain excitement of life is the journey.

Why should we be surprised, then, if a couple endowed with the talent, the endurance and the charisma to pursue the presidency of the United States should not renounce this aspiration just because a serious disease may cut their life short? Mrs. Edwards must believe that her husband is the best candidate for the presidency, arguably the position in the world that may touch more human lives than any other. Would it not be terribly selfish of her to claim her husband for herself rather than helping him to develop his full potential to serve other people? After all, this was the promise of their wedding vows. And this example of selflessness would certainly represent the most lasting gift for her children. What better boost to their self-confidence than the certainty that only a life of service is worth living?

Dying may represent a unique opportunity to distill our lives to what really matters, what truly makes us feel worthy.

A tourist who has only 24 hours to visit Rome may elect to run from one monument to another trying to pack as many experiences as possible in a limited time. Most likely, at the end of the day he will be confused, exhausted and disappointed. Or he may decide to climb one of the Roman hills, such as the Gianicolo, from where he can gain a global impression of the city and chose the monuments he really cares to visit. Then the short visit may become really memorable.

The proximity of death may represent our personal Gianicolo with a global view of our personal lives, highlighting what matters to us. The Edwardses have shown that it can be done, and have led the way.

Dr. Lodovico Balducci is a professor of oncology and medicine at the University of South Florida College of Medicine and is director, Division of Geriatric Oncology, at the H. Lee Moffitt Cancer Center.

[Last modified April 1, 2007, 01:06:47]

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