As the glittering ball descended on Times Square to mark the last seconds of 2012, I gave thanks for another year of living on borrowed time. You might wonder why I chose this metaphor to describe my survivorship. What exactly do I mean?
After my diagnosis of lymphoma in 1990, day or night I could tell you instantly how many cycles, months or weeks of chemo I'd finished (or still had ahead of me), just as I'd eagerly counted down to the end of each pregnancy a few years earlier. The day my chemo-nurse applied a Band-Aid to the puncture site of my final infusion, I walked out of the office on wobbly legs into an uncertain future.
Less than a year later, my first recurrence telescoped my time horizon. Visions of growing old vanished. The “seven-year median survival” statistic that had haunted me since my diagnosis now sounded like wishful thinking. Making plans for anything further out than a few weeks was fraught with anxiety, a problem that worsened after my second recurrence.
To both calm my fear and deal with the uncertainty about my future, I strove for hopeful acceptance, namely, accepting my poor prognosis while hoping my imminent treatment in a Phase I trial would buy me more time. Hope won, and I joined the ranks of a new breed of long-term survivor that hopscotches from one new therapy to the next.
In the middle of my fifth remission, the seven-year anniversary of my diagnosis came and went unceremoniously. The milestone didn't go unnoticed, however, as I began referring to my survival as “living on borrowed time.”
At first I meant the idiom in its traditional sense of having delayed or escaped what had appeared to be certain death—hence, living on time “borrowed” from death. In and out of treatment, I was rattling around beyond anyone's reasonable expectations. Over the years, though, my sense of living on borrowed time has taken on new meaning, having nothing to do with how long I live. The operative word here is “borrowed.”
We all know what it's like to borrow something, with the excitement, empowerment, and other pleasurable feelings that can arise. Even old and ordinary objects are new to us, which makes them special.
In addition, borrowing can trigger emotions similar to the glorious joy we experience after finding something that was missing for a while. The difference is the timing. After recovering a lost object, from then on we may appreciate the item far more than if we'd never lost it. Meanwhile, in anticipation of returning a borrowed item—in other words, before losing it—we may savor the experience of having the borrowed item more than if we owned it.
Also, with a due-back date looming, we may feel an urgency to decide when and how to use the borrowed item. Meanwhile, owners may choose to postpone these decisions, assuming they can think about them tomorrow.
Lastly, as stewards of someone else's property, we borrowers may feel responsible for protecting it from damage or loss. So we treat it gingerly—more so than if we received the item as a gift to keep.
But what does it mean to borrow time? And from whom are we borrowing it?
People of faith may view their time as belonging to God. On rare occasions, patients diagnosed with cancer refuse treatment, believing their cancer is divinely ordained and reluctant to interfere with God's will. Others of similar faith feel inspired to do everything humanly possible to survive. These patients interpret cancer as a sacred challenge—not a verdict—and look to God for courage, strength, and fortitude to help them honor and preserve their God-given time on earth.
Whatever a person's spiritual beliefs, a secular way of looking at the metaphor assumes that each of us has an allotment of time. We may perceive the length of our lifeline to be determined by ever-shortening tails of chromosomal telomeres, the whims of the inscrutable Lady Luck, or some other manifestation of destiny. In this context, we are borrowing time not from a “who” but a “what,” the way we borrow money from a bank.
The defining feature of living on borrowed time is a willingness to look at and eventually accept the limits of one's time on earth.
As a young, busy internist before my diagnosis, I saw many lives cut short or transformed by illness or injury. I knew—and believed—that my white coat did not protect me in some magical way. Yet at work and home I acted under the assumption that I had tomorrow to tend to whatever didn't get done today.
Cancer changed all that. Stripped of confidence in my future, I had to figure out how to manage my fears. The idea of living on borrowed time has been healing, because it uses my heightened awareness of the limits of my life positively to help keep me focused on all I still have today.
Clinicians may find this interesting, even inspiring, but how does the notion of living on borrowed time help you care for patients?
You share with patients the knowledge that the human condition is one of limited time. Compassion begins with acknowledging that many cancer patients understand this on a new level after facing their mortality. So while some patients who mention “living on borrowed time” intend it simply as a figure of speech, others may mean more.
For me, the idea of living on borrowed time is an invitation to accept the mantle of stewardship of the hours in each day and the opportunities they contain. Sick or healthy, “living on borrowed time” is a metaphor that encourages us to live mindfully and purposefully in the bounty of our lives, however long that might be.