Over John McCain’s long life of extraordinary service, he gave us many lessons in courage and character. He forged his reputation as a hero in the crucible of imprisonment and torture in North Vietnam and he carried the blessings and burdens of the label “hero” the remainder of his life. Ideological debates and political battles, won or lost, never hid the basic decency and bravery of this man.
And so it is with his death. McCain battled an aggressive brain cancer called glioblastoma that he understood would likely kill him. Glioblastoma is rarely cured. If surgically removed, it almost always grows back. Median survival is 12 to 18 months. McCain gave his best effort to beat it back and extend his life. But like any wise and sober champion, he stood tall in defeat and refused to squander human dignity to battle a lost cause. Instead, at the proper time, he chose to retreat from the cancer battlefield with a noble grace and integrity.
Studies show that about 80 percent of Americans would prefer to die at home, yet only 20 percent actually do. Another 20 percent die in nursing homes, and 60 percent die in acute care hospitals, where they are more likely to have suffered needlessly from aggressive and painful interventions. McCain appeared to shun a frantic pursuit of immortality that might have set him on a course of invasive, burdensome and ultimately futile travel, treatments and procedures. Some public voices continued with vapid assurances that he would “beat” his cancer, but other colleagues understood his priority to be the heroic closing of a life.
McCain spent his last months in the quiet of his home, with those people and things dearest to him. He drew in the beauty of his natural surroundings, welcomed friends and family to his side, shared memories and affection. He showed us how to finish a remarkable life in a remarkable way. May we once again learn from his example, and observe what heroism looks like when death is imminent and inescapable. Over 25 years as a nurse and physician assistant in emergency rooms and intensive care units I witnessed no greater heroism than his.
How we die matters. As physician and author Atul Gawande writes in his landmark 2014 book, Being Mortal, “Life has meaning because it is a story. And in stories, endings matter.”
McCain’s example is a refreshing counterpoint to the dominant American stereotype of a hero battling terminal cancer defiantly to the end, never admitting defeat. In America illness, and especially cancer, is just an enemy to be conquered. Americans expect a hero will fight the force invading their body, beat the occupier and win the battle. A countervailing narrative, of graceful surrender to the certainty of mortality simply does not exist in our prevailing story of aging and illness. Thus, we describe those who die as “losing the battle” with cancer, and always with the silent question of what it would have taken to “win.”
As our internalized story goes, we need two things in order to be victorious in our “fight.” First, we need courage and the will to wage war and persist through multiple battles. In order to prevail against cancer, in particular, we must muster a single-minded focus, a mighty endurance and a high tolerance for suffering.
Second, we need hope. By this we mean only one kind of hope — the hope that medical treatment will achieve a total cure and postpone death indefinitely. Irrespective of evidence to the contrary, most impulsively retain a goal of ultimate and complete vanquish of the enemy from the territory of their bodies. For many people, to “give up hope” for cure means being a “quitter.”
They believe hope for cure must never die, heroism will be rewarded, and cancer can always be overcome. The problem with this belief, of course, is that death is certain. So if to die is to “lose” then every human being, no matter how courageous, persistent, loving or eager to live, is a “loser” who “gave up.” That can’t be right.
The death of John McCain may help our nation overcome false stories of courage versus cowardice, of holding hope versus giving up. None can doubt John McCain’s ability to endure pain and suffering, nor his abundant hopefulness.
Ultimately, we must accept that sometimes cancer takes the courageous, the best and brightest stars in the human constellation as surely as it takes anyone else. Courage and determination are ultimately no match for an aggressive, invasive cancer destined to kill. The fantasy of overcoming cancer, or any terminal illness, with shear will power is just a cruel delusion. The idea that cancer kills only quitters may comfort us temporarily and insulate us from fear. But the comfort and insulation come at a price. We inadvertently abandon those who have fought the good fight, but are finally ready for gentle resignation. We press people who admit their end is near to ignore their deep suspicions or intuitive understanding, and fight on. We steal the time they would otherwise have to close their lives and say goodbye. We rob them of the dignity of consciously and nobly taking their place in the great cycles and mysteries of life.
We need a new story of heroism at life’s end, as inspiring as any feats of courage on a field of battle.
The new story, the McCain story, is not about losing hope or giving up. It is still a story of brave soldiering and valiant victories. But this one ends with a gradual, eventual recognition that bravery can no longer carry the day and the time has finally come for graceful retreat. A single heroic act is the turning point in this story. That act is the conscious recognition that a life has been completed and the time has come to die. This story acknowledges that no treatment has ever made a person immortal and death eventually comes to us all. This story, McCain’s story, is a heroic narrative for accepting the fate we share with all living creatures and exit this life in peace and grace. Thank you, Senator McCain, for one last lesson in heroism.
Barbara Coombs Lee is president of Compassion & Choices, a national end-of-life advocacy organization. She is the author of an upcoming book, Finish Strong: Putting Your Values and Priorities First at Life’s End, and previously authored Compassion in Dying: Stories of Dignity and Choice (New Sage Press, 2003).