Bill Keller's Column on Cancer: A Reaction: The New Yorker For good reason, the Internet lit up on Monday with debate over Bill Keller's strange column "Heroic Measures," in the Times, which, like a recent Guardian post by his wife, Emma Keller, addresses the ethics of publicly chronicling one's battles with cancer. Emma Keller's post was taken down by the Guardian on Monday. The occasion for both editorials are the tweets and blog posts of Lisa Bonchek Adams, who is being treated for metastatic breast cancer (Stage IV). Adams, as Emma Keller writes, has tweeted more than a hundred and sixty thousand times, often about her illness. (A recent example: "Another shoutout to the palliative team. Pain management specialists are some of my heroes @sloan_kettering.") Both columns betray discomfort with the public nature of Adams's response to her illness. And both writers veil what appears to be personal distaste for Adams's public display with high-minded questions about the ethics of prolonged care and of public self-revelation without examining the complexities of their own response. In this way, both columns are a stark and tone-deaf reminder of just how repressed and ahistorical our public relationship to dying and death is today. It's a shame, as both writers touch on interesting questions about how we think about those issues, questions of the very sort that Adams has been trying to address in her blog posts and tweets. Other writers have already effectively characterized many of the problems with Bill Keller's column, which contrasts Adams's decision to pursue treatment, despite the gravity of her cancer, with his father-in-law's "calm death." But perhaps the most salient point is that he used one woman's story as an occasion for debate about what might be wrong with broader approaches to dying. I'm sympathetic to some of Keller's larger points, especially those about our collective difficulty with facing dying, our cultural habit of pursuing treatment past the rational point of stopping, and the importance of medical centers that offer alternatives to highly interventional care. But, as Keller barely pauses to acknowledge, such collective issues break down into millions of complex individual realities - realities that go largely ignored in his Op-Ed, which treats Adams's personal choices as an occasion for moral legislation about the wisdom of resigning oneself to death. It is very different to be faced with late-stage cancer at seventy-nine (the age that Keller's father-in-law, Anthony Gilbey, was when he died) than to learn at thirty-seven that you have breast cancer, as Adams did. When Gilbey chose not to pursue life-prolonging treatment, he was nearing the end of life; when Adams learned her cancer had metastasized, she was in her forties with three children. A debate about the rationale for extending treatment looks very different when it concerns those who have lived the bulk of their lives rather than those who are halfway through theirs. Keller writes, "Adams is the standard-bearer for an approach to cancer that honors the warrior, that may raise false hopes, and that, implicitly, seems to peg patients like my father-in-law as failures" - a strange thing to assert. Very few of us, I think, would consider a forty-year-old's decision to pursue treatment to be a referendum on an near eighty-year-old who has had a failed cancer surgery. Adams herself has written on her blog about the problems with the "warrior" approach to living with late-stage cancer. Indeed, one of the most startling things about both pieces is their lack of historical awareness or broader context. If Twitter is novel, a public deathbed is nothing new; in earlier centuries, it was a custom to die in public, surrounded by friends and townspeople. When Christopher Hitchens wrote about his terminal esophageal cancer in Vanity Fair, his columns were mostly praised, no doubt partly because they were filtered into literary form. And searching for cures - even in unlikely places - is hardly a uniquely contemporary American pastime. Just consider a text like Alphonse Daudet's "In the Land of Pain," which comprises notes that the nineteenth-century French writer made while living with syphilis and searching high and low for a cure; the notes were gathered and published posthumously, and when Julian Barnes's translation came out, in 2002, the book was praised for capturing "the indomitable spirit of life." What Adams is doing is not new - it is not even new in our time. But it is less filtered and more immediate than ever, and surely this is part of what's at stake here: a lingering concern that dying perhaps deserves contemplation rather than immersion. I can understand, in a certain sense, how each Keller was jolted into contemplation of Adams's public persona. I am Facebook friends with Adams - she must have sent me a request a while ago - and before the Guardian column appeared, in late December, I had been similarly struck when I opened my Facebook feed (usually an assortment of puppies, babies, and complaints about signing up for Obamacare) and found posts by Adams detailing what it's like to be in the hospital unable to control her pain, or the indignity of having visitors drop by without notice. I didn't know her personally, and these posts felt highly personal, and different in kind from the buoyant mundanity of the rest of my feed. But there is something useful about the disjunctiveness of posts like hers, which pop the bubble of the social-media surfaces that we slide along, as if our time here were a never-ending river rather than a journey that has a distinct end. I also welcome debates about what the ends of our lives might look like. While many of the questions addressed in each column could have led to a worthwhile discussion, their approaches were ad hominem and, at best, insensitive to the lived realities of Adams's life. She may be allowing us to overhear her decisions, but she is not asking us to callously debate them as if she were not still here. The fact is, as Keller intimates, it may indeed be better for patients to "accept" their own deaths - a study I came across when I was researching my book suggested that a patient's "acceptance" of her death makes the grieving period easier for those who survive her. But "acceptance" is not something we can merely choose, like a bento box at the neighborhood sushi joint. It would no doubt be better if each of us experienced less terror in the face of death, more pragmatism about medical choices - if we lived in a culture that taught us, from our youth, to be mindful of our mortality, wise in our apportioning of time. But even in such a culture, it's hard to imagine many forty-year-olds going gentle into that good night, to paraphrase Dylan Thomas; in the twenty-first century, to die in your forties is to die early. It's crucial to remember that, when faced with an individual death sentence, no one knows - not a single one of us - whether treatment is in fact the pragmatic choice. When my mother was diagnosed with cancer, in 2006, it had already spread to multiple organs; from a certain perspective, it was likely that she didn't have long to live. But after a round of what her doctor called "industrial-strength chemo," which made her very ill for two months, she went into a total remission for a year. During that year, I got married, she and I travelled together, and she was there for all three of her children (the youngest of whom was still in college) in ways that we are all forever grateful for. But if she'd chosen to do nothing, that would have been her right. Dignity, really, is the right to do what you want to do. Yes, we need to educate ourselves and our doctors to understand when it might be the right moment to let go - but none of us know if Adams is at that moment. And none of us can make (or should make) that decision for her. Illustration by Victo Ngai.