Gratitude: In Sickness and Health

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I remember staring up at the ceiling from the dentist’s chair as a child and wondering with genuine perplexity, “How am I here again?” It seemed as if I had awakened there, wholly present to the undeniable reality of a cavity filling or tooth pulling. The days that had passed between dental visits were nothing more than a dreamlike filler. Only in the chair did real life flare back into being, the drill keeping me relentlessly awake to the present moment. In the grip of pain, a tinge of anger would arise. How had I let all those carefree days slip past me in what felt like an instant?

I spent a great deal of mental energy in my adolescence trying to capture that dreamlike filler, to perpetually feel what the Buddhist teacher Thich Nhat Hanh calls the “non-toothache” that I unknowingly walked around with most days. It was an exercise in imaginatively conjuring pain in order to appreciate its absence. And not just ordinary pains, but colossal ones. I was looking up the road of my life to see epic losses — of health, of kin, of life itself — and feel the weight of ensuing grief. I wanted to harness that emotional energy, to have it reinfuse my sense of wellness. I wanted to transform future loss into present gratitude.

My efforts proved futile, as loss came too soon. At 24, I was found to have a rare and aggressive bone cancer. The year of chemotherapy and surgery that followed whittled away even the most basic capacities whose true worth, I learned, was impossible to capture through imaginative effort alone. The ability to walk, to keep food down, to defecate without electric pain were no longer mundane givens, but miraculous gifts. In their absence, the vibrancy of illness burned brightly.

As treatment was nearing its end, my hope of finally being released from its prison was muddled by a subtle despair about life beyond its walls. If a year of backbreaking lows and mind-bending pain would ultimately be erased in the fog of complacency and ingratitude, what did it all amount to? I needed to retain that vibrancy, to resist being lulled into trance by the hum of wellness from which I had struggled to awake since my days in the dentist’s chair.

But as my health returned, the vibrancy did fade. Now almost five years in remission, I notice myself falling back into that same pattern of trying to harness the vibrancy of illness, of forcing myself back into the dentist’s chair to avoid my failure to feel the non-toothache. I am learning, however slowly, that maintaining that level of mental stamina, that fever pitch of experience, is less a recipe for enlightenment, and more for exhaustion.

The existentialist philosopher Jean-Paul Sartre describes our experience as a perpetual transitioning between unreflective consciousness, “living-in-the-world,” and reflective consciousness, “thinking-about-the-world.” Gratitude seems to necessitate an act of reflection on experience, which, in turn, requires a certain abstraction away from that direct experience. Paradoxically, our capacity for gratitude is simultaneously enhanced and frustrated as we strive to attain it.

Perhaps, then, there is an important difference between reflecting on wellness and experiencing wellness. My habitual understanding of gratitude had me forcefully lodging myself into the realm of reflective consciousness, pulling me away from living-in-the-world. I was constantly making an inventory of my wellness, too busy counting the coins to ever spend them.

Gratitude, in the experiential sense, requires that we wade back into the current of unreflective consciousness, which, to the egocentric mind, can easily feel like an annihilation of consciousness altogether. Yet, Sartre says that action that is unreflective isn’t necessarily unconscious. There is something Zen about this, the actor disappearing into the action. It is the way of the artist in the act of creative expression, the musician in the flow of performance. But, to most of us, it is a loss of self — and the sense of competency that comes with it.

My attempts to harness the vibrancy of illness have largely been to avoid this plunge into the present. Before cancer, I would strain forward to my future self, the one who had already endured loss. He was the older sage that I have always intuited — helplessly, hopelessly — I am on my way to becoming.

After cancer, I’ve clamored backward to my past self — the one who knew pain, the glaring absence of things. He was the younger, battle-tested soldier whose courage I feel, on most days, has been lost.

Both these selves are removed from me now — not by distance, but by degree. The sage is lost to speculation while the soldier is trapped on the other side of some existential barrier that even memory — no matter how vivid and haunting — cannot penetrate. There is grief in realizing that, in holding one’s ear to that wall, exiled to the other side of pain.

I am left with one thing: my ordinary, present self who is as empty-handed as he was the day before diagnosis — no better equipped for the ensuing battles of life, no better shielded from pain he will yet face. And it is not just heroic pain. It is the hurt of parking tickets, the ache of commuting, the grief of deadening routine — small pains to which I was immune while they were eclipsed by cancer. But that moon has since passed.

And yet, that isn’t reason for despair. It’s strangely consoling to be reminded of my failure, to remember that my efforts to be prepared for epic loss were mostly in vain. I wasn’t ready then, and yet, I got through it. I won’t be ready next time, but I have reason (and experience) to believe that I will get through it again.

If there is any sage in me, he says I must accept the vulnerability of letting the pain fade, of allowing the wounds to heal. Even in the wake of grave illness — or, more unsettlingly, in anticipation of it — we must risk falling back asleep into wellness.