Interview with Meredith E (mortal atheist)
I connected with Meredith through the blog when she reached out in January 2023. We quickly bonded over our shared love of documentaries, cats, and our rocky relationships with audiobooks ;) Meredith is 42, an atheist, and has terminal cancer. She offered to share her story here.
Cancer diagnosis
I had breast cancer in 2009, when I was 28. At that time, it was stage 2. When the second diagnosis came along in 2017, I had assumed the cancer was behind me – I’d passed the 5-year mark and was down to annual check-ups only. I didn’t have a lot of time to think about it, it was serious and I was hospitalized. I had had a double mastectomy, but they think the cancer had migrated past the lymph nodes, even though the nodes had been removed. My doctor told me that there was no surgery to be done, that I’d go through chemotherapy until I ran out of options, or until I died (my doctor did not put it that frankly). My cancer is hormone-driven, so there were a lot of different chemo options. I did almost 6 years of various chemos. The last two had a 50% chance of working, but neither worked at all. In the fall of 2021, I asked my doctor for a prognosis, and she estimated I had 18 months left. That would put me around March of 2023 (last month). My doctor was always good at balancing good and bad information, you know, “here’s the good and what you can do with it,” but that was hard to hear. There are technically other chemo options I could try, but the one likeliest to work has <20% chance, probably even less than that. The decision not to try additional chemo felt pretty natural. None of my friends or family tried to convince me to continue, but it’s been very hard for my husband and my family.
It’s been a while since I left religion, but I take pride in not reaching for religion with either cancer diagnosis. If anything, it shored up my atheism – I felt like I could get through this without reaching for faith, and still haven’t had that need. And it would have been easy to turn to religion to cope, but I could never turn my brain off in that way. It would have felt like a false note.
Anxiety and anticipatory grief
Sometimes I think of my existential anxiety as both too big and too small of a problem. I believe it will be the end of my personal, unique existence – the loss of myself – what could be bigger than that? And, at the same time, ending my existence will put me in the same place as I was before being born, so what's the big deal? I believe that when my body dies my consciousness will end, so why should I worry too much about that? I think that as humans we're just not well-equipped to contemplate our own non-existence, but I want to go to the end with my eyes wide open. Mostly the anxiety I feel is for the people I love, and I still get hung up on the loss of the self and who that is to the people around me. I have anticipatory grief, knowing how hard it will be on them.
Psilocybin and ketamine
All of this is partly why I decided to try psilocybin and ketamine injections. My experience with psilocybin was disappointing. I know that people can have transformative, transcendental experiences, and part of what fueled my interest was my husband’s teenage experience with it, how he described seeing the continuation and persistence of nature and having a sense of interconnectedness. I was open to what the secular experience would be. When I took psilocybin though, I didn’t have any of that. Perhaps the rug looked a bit more interesting? It’s possible that the SSRI I am taking interfered with the experience, so I am weaning off that. I tried ketamine injections next. I expected the first time to be a joyful experience, but instead it was disorienting. The second dose made me feel more expansive, like I was no longer constrained by the dimensions or outline of my body. I wanted more to feel a sense of connection and I didn’t really get that, but I did get some weird imagery. I definitely felt blissed out for a bit afterward, but then the anxiety just came trickling back. I also got a headache and felt kind of nauseous after. I’m surprised that people do it recreationally! By the end of the fifth ketamine session though it was amazing, and after I had completed all six sessions there was a marked decrease in my existential anxiety. The nurses said that results usually last for 4-8 weeks and that I can do a "booster" dose whenever I want it. It was a very meaningful experience (though I'm still an atheist!). I wouldn't hesitate to recommend ketamine injections to anyone struggling with that type of anxiety.
Death doulas
I think everything would have been harder if it hadn’t been for my death doulas, Kim and Annie. Annie is my age, has curly red hair like me, and also majored in anthropology. It is nice having someone I can talk to about death without having to worry about their emotional comfort, if I’m being too grim, or if they’ll react badly. That is very freeing. The other doula is Kim – she considers herself a party planner for death. She likes organizing and arranging, so she put together a binder – including what I want my last moments to be like, what I might want for a memorial service, a draft obituary, and the paperwork for donating my body to a “body farm” here in Colorado. Between the two of them it’s kind of a combination of traits that are really good to have in doulas. They both have asked questions that led me to talk about being an atheist. It was something I included in my initial messages to all the doulas I contacted. A few I never heard from, and some seemed a little hesitant to work with an atheist. Annie and Kim were both upfront saying working with an atheist was fine without talking about their own beliefs.
MAID (Medical Assistance in Dying)
One of the other things that I included in my initial messages to Annie and Kim was that I was considering MAID and I wanted to make sure that that was something they were comfortable with. I had been chugging along in treatment for a few years knowing that there were still a lot of other treatment options, so I hadn’t put a lot of thought into what the end would look like. I watched a documentary called the Last Flight Home, and that made me remember that MAID was an option (it’s been legal in Colorado for a few years). The books I’ve read have been very reassuring that death is a natural thing and that it's going to happen to all of us, and a lot of the books worked very hard to show that with proper hospice care death doesn’t have to be a terrible, painful thing. But I’ve also heard stories that weren’t so great (maybe there’s not a market for those books!). To me, being able to have MAID as an option provides some relief, and I made my official MAID request in mid-January. I’m not positive that MAID will be my final decision, but I wanted to do the legwork so that it’s an option and I’m not scrambling for it at a later date under more dire circumstances. Making the actual request was heavy and emotional, but now I feel lighter. Rather than taking a tough step, it felt more like crossing an unpleasant task off a to-do list. While it is hard for the people in my life to know I have a terminal disease, that I have some level of control over it is something that they’re all grateful for. I don’t think it’s the type of thing that I would want to pursue if it wasn’t legal… that would be a lot to put on loved ones.
Meaning/purpose
What I find appealing is trying to leave the world a better place than you were born into, to do your own little part. I’ve been thinking too lately about leaving behind a legacy of love and kindness. One of my family members is a Methodist minister and he had a phrase: a life well-loved is a life well-lived. It’s pithy, and encapsulates everything, right? I have struggled with whether something can have meaning if it’s temporary, wrapping my head around my own mortality and trying to come to a place of peace and acceptance… but does that matter if I’m going to die anyway? That felt like a stumbling block I had to get over. Without religion, without that authority figure, we have to figure it out ourselves – we can’t use the Bible or rely on someone else to tell us what to believe. I still have tendrils of that in my brain sometimes… if the earth is going to be blotted out one day, does any of this matter? But then it almost feels like it matters more because it’s ephemeral.
In the end
It’s probably a very human thing to have existential anxiety hardwired into us. I don’t know if there’s something I could have been doing all along to make dying easier. It kind of feels like the early exposure to cancer pushed my brain toward knowing that I might have a shorter life than the average. That helped make the stage 4 diagnosis less terrifying than it would have been. I think it’s just little steps of exposure therapy. That was something I was consciously trying to do by finding the death doulas last summer. It feels like oh, it’s probably time that I should put more effort into contemplating death.
With the first cancer I went through I tried to manage other people’s expectations, worrying about how everyone else was feeling. This time, it feels less that it’s my job to make everyone feel better about what’s happening to me. I feel a lot of gratitude – for my family, that my education was encouraged, that I found someone I love who also loves and cherishes me, that I had the chance to be a sentient being. And 40 years was a good amount of time to get not too long ago! I’m grateful that I’m living in an era where hospice care has evolved to where it is, that I don’t have to be as anxious about dying. And once I am in hospice there are other drugs that my medical team can offer, so I am reassured that I have that option. Honestly, if someone had told me before that practicing gratitude would help, I would have chucked a plate at them. But it does help, and it feels like it sprung up naturally as a coping mechanism.
Not a lot of us have the influence of a president, or a king, or can make huge policy changes. While I haven’t left behind any big academic accomplishments, or built any pyramids, some small piece of what I can do is be an example of how to face death.