When the mirror cracks

Not cured, cancer takes a downward path, which despite the occasional hopeful rise descends until the inevitable end.  I have attended this sad journey so often that while I may be drained, I am rarely surprised.  However, my patients and their families are often deeply disturbed by what seems to be a sudden happening.  Usually, the blame for this shock falls to fear and denial of the reality of death.  However, what if the primary drive is not fear at all, but instead is love?

Now of course you say, “Well, that is obvious, we mourn and fight for the one’s we love, we always deny their coming death.”   While true, I suggest something subtler, more complex; an idea basic to the nature of love.   Love draws us close to others and creates a mutual dependence, trust and bond which transcends all other emotion.  But, whom do we love, who do we need and whom do we see?  Like a mirror, which reflects only the past, we see the person of yesterday.

Marcel Proust, in the classic In Search of Lost Time, writes, “…Every habitual glance is an act of necromancy, each face that we love a mirror of the past. “  We do not see the changes of time in ourselves, and especially in those that we love.  We fail to observe how those most precious to us have aged, looking past the shallow changes of the body and seeing rather the brightness in the eyes, the excitement of the mind and the depth of the heart.  We do not even see the eyes, mind and soul of today. We see the person we came to love so many years before, as by habit we deny time.

It is simple to conclude that our failure to see time’s ravages is just another facet of the denial of death.  By clinging to a brilliant past, the moment we met in college, the magic of birth, the wonder of a holiday ritual, we deny that time kills.  I do not see the changes in my spouse, and because if my wife is still the perfect physical creature from those first days together, she can never die.  I am certain there is truth in that idea.

Nonetheless, perhaps this misses what is basic in the nature of love.  We bond not just to the body, the face, or even the eyes.  Love is the connection of souls and that link, while it becomes stronger with the years, is welded in those first early moments.  We do not see the change in the mirror and the corruption of the body, not because we want to deny the future, but because we adhere to the essence, spirit and power that both was and is the person we love, and thus we hold in our mind the presence of past days.

We do not fall in love again with the “new person” who is born with rising each morning. By habit we do not look closely at the one with whom we share a family, a house or a bed and thus are blind to the change of bodies with time.  While we may adjust at a superficial level; yes, we cannot walk as far, or yes, she needs to take pills or yes, he is receiving chemotherapy, in the crystal statue held in our mind that person we so deeply love is still young, perfect, vibrant and time has not altered.

Therefore, when devastating disease strikes, our “habitual glance” preserves the one we love intact so that “the idea we have always had of them,” makes it incredibly difficult to accept terrible change.  This is not simply the denial of death; this is the image of that person in the bonded mirror of love.  Perhaps, even more than fear of loss and death, it is a celebration of life and love. Nonetheless, what makes it so hard is that our hearts fall to pieces when the mirror is broken.


  • Linda DeLia
    Your writing is powerful and your observations are profound. This essay is one I'll save to reread when my mirrors crack. Thank you!
    • James Salwitz, MD
      Thank you very much, jcs
  • Liz
    I think maybe it is also hope - hope that things aren't as bad as they look, could be, might be, are... And change, watching it one minute at a time every day up close and personal, is harder to see than if you only really get to look once every couple of weeks, months, years...
    • James Salwitz, MD
      Yes, indeed, hope ... always hope. jcs
  • So beautifully written. Like Liz, I too thought about hope as I read this - and how malleable hope can be in end-of-life care. The nature of hope can change (but for the patient too) from the time of diagnosis (I hope the test was mistaken) to treatment (I hope this will cure me) to palliative care (I hope I won't have pain) to our final moments (I hope my family will not suffer because of my journey). "Our hearts fall to pieces" indeed. Thank you for this.
    • James Salwitz, MD
      A wonderful point, that hope itself shifts with time and therefore is not the same as denial. Thanks, jcs
  • Mary
    Wonderful, really wonderful. I will add, the mirror we most often see is in the eyes of others. If their eyes light up, we see ourselves as loved, and vice versa. I think that this is an underlying that we have the recent discussions on the lack of eye contact between patients and doctors. This also applies to my marriage. My husband was often deployed for over a year. The low point was when he got off the plane, and he walked past us. He didn't recognise me or the children, and we didn't recognize him. I asked if everybody was off the plane. Then I took a look at the passengers. I realized that one man walked like a deep water sailor, and I yelled my husband's name. The stranger was him. I can't describe the sadness that we all felt. There are many types of death, that was one.
    • James Salwitz, MD
      I wonder if one of the reasons we do not see the change in others is that we worry how we might hurt the one's we love by showing that change in our eyes. We protect not only ourselves, but even more important those we hold precious. That moment of "death" when you and your husband did not connect must have been terrible ... a reminder of the time that past which you were not able to share which was soaked with worry and loss. I hope that you were able again to find each other and mend. You and your family's sacrifice honors the Country you serve, but is very difficult to repay. Thank you, from my heart. jcs
      • Mary
        Our marriage lasted until a few years after he retired. I no longer was the naive, dependent 18 year-old. If we had a problem, I couldn't wait 6 weeks or longer for a reply. I had the strength to learn and not depend on any man in any way. I loved him and our marriage bed, was faithful to him, but I was used to taking off with my team roping buddies or repairing the roof. He wanted the wide-eyed 18 year-old that he thought that he married. When we broke up- he went and lived with a girly-girl. That lasted 6 weeks. He ended up marrying a female Texas sheriff that can out shoot me, but can't out ride me. This will crack you up. When he first got out, we wanted the same thing-for the other one to make decisions and to be cared for. Neither one of us wanted to make a decision about repairing a truck or buying a new one, etc. The kids-15 and 16 took over those decisions for a while. I feel so sorry for the modern military and their dependents. The physical and emotional grind of constant deployment, especially the time of losing homes, apartments because of screwed up banking, but my generation had a family of 5 in a 20 ft. trailer on a Marine Base, I actually knew people that lived in chicken coops. The stress the children endured at school because their "Daddy was a baby killer in 'Nam." At least they have Skype, etc. and they should know what their spouse looks like, and they don't stay deployed for 2 years. . Aircraft carriers were deployed for 18 months and with 'Nam it was longer, the break was to go to Japan or Thailand.I just pray that we don't get involved in Syria-our military and families are at the breaking point, where even Skype doesn't help that much. The aircraft, ships, USMC tanks are wearing out, which stresses out the personnel and families even more.
        • James Salwitz, MD
          I pray that level heads are listening to your wise advise. The depth of sacrifice made by military families as well as the men and women on the front lines has incredably deep effects on our Country. Drones do not have loved ones, and drones will never be enough. jcs
          • Mary
            While talking about carriers, my husband was what today we call special forces. He often was the only American in a fire fight-attached to ROK marines and RVN navy and marines. We lived by different rules than the others. What friends he had usually were killed. Then he was spit on-that tore my kids up when they saw that. My kids came out OK. I think it's bc I didn't dump on them, drink, or run around. They knew and know their father loves them.
  • Really wonderfully said. Over time the corruption of the body and soul is not always observed by those whose imprinted loving memories are suddenly misplaced. The physical descent and moral descent of individuals is overlooked. I think it works both ways sometimes for physically and spiritually healed individuals. Thank you again for an insightful and profound post!
  • In 35 years as Med Onc, I saw only one joyous death. The patient, a woman of about 60, was the Arranger and Conductor. She died a respiratory death, struggling for Oxygen 40+ times a minute, but she was beatific. She had her children around, she was safe in her God, and she had done all she'd set out to do, I guess. She turned the agony of terminal dyspnea into a joyous event for her loved ones. She reassured them that she was all right, and meant it. She was SMILING. I never forgot it.
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  • IBS
    I was walking into the store trying to find a larger size to fit my cancer body. Yes, you read this correctly; larger size. I was rolling my basket with nothing in it. All of a sudden I hit an old woman, unintentionally, with the basket. I was so sad. She was so sad. Her eyes were watering with droplets of salty water running down her pale cheeks. Our baskets intermingled with one another and I asked, "I'm so sorry. Are you okay?" She looked familiar to me. Who was this woman, I thought. Do I know her? And then I looked at her one last time. I was looking through a large mirror reflecting myself. Palliative Care patient

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