I’m going to attempt, here, some in-depth discussion about the intricacies of survival and transplants. I hope it’s of some interest.
There is a wonderful piece of art called Transplant. It was born of an artistic collaboration between Tim Wainwright and John Wynne (2008-2009). I plan to interview them about it for a Static TV production early in 2010, actually (watch this space!). The piece includes an installation, DVD, website, and book. In audio, still image, reflective/ analytic writing, they represent – and allow the presentation of – fifty patient experiences and reflections of their transplant procedures. Over the months of interviews, and amid the expected praise of staff dedication and expressions of satisfaction with their care, some patients expressed metaphysical ponderings and intricate descriptions of hospital machinery and the sounds with which they are constantly bombarded whilst waiting in their hospital beds for weeks, months, years. Alongside these were recorded soundscapes of the modern ward, and essays of health-care professionals and artists. On the DVD alone, a great variety and depth of thought is provoked: ‘I don’t feel no different [sic]‘ says one patient, while another claims that he has ‘quite a surreal existence, really’. Watch a little longer, though, and other patients have obviously had darker thoughts about their situation: ‘it’s awful because you think: “someone else has died”. I just try not to think about it too much.’ Towards the end of the DVD, a man, in a matter-of-fact manner, speaks his sentiments:
‘Like my father, I think, I had totally acclimatised myself to the fact that I was going to die and I’d never been frightened of dying, as a lot of people seem to be. So I just accepted the situation… I’d caused it, it was my fault. What a shame! I’m going to die a bit sooner than I would otherwise have done. So, a few weeks after my operation the staff thought I was depressed and called in the psychiatrist and, in actual fact, I wasn’t depressed. It had suddenly dawned on me that: “hang on! I’ve got so many years to live now. What do I do now?”
It is this ‘acclimatisation’ to the inevitability of death and sudden snatching away of this moment that may open the discussion and I’d rather like some thoughts on, if I may ask such a thing! Here, though, I’m going to compare that experience to a story by the writer and philosopher Maurice Blanchot. I say ’story’, though the word doesn’t feel appropriate:
Nazi soldiers sentenced Blanchot to death by firing squad when he was young. He later wrote of this experience as though he did die after resigning himself to death. That is his ’self’ died. Obviously, his body still had something going on inside of it – it still had an ‘I’ but it wasn’t the same ‘I’ as before. I’m going to try to argue that this experience of Blanchot’s ‘I’ being fractured (thus his identity and self no longer complete) is comparable to that of the patient I’ve just mentioned above. Something residual is there; an ‘I’ of sorts has been constructed but he is dead.
That was in his The Instant of My Death. And this is the story in short: upon being rounded up with his family and led outside by Nazi soldiers, a young man [as Blanchot was writing in third person] was lined up in sight of the firing squad and, encountering his last moments – or what he thought were his last moments (they were ‘his’ last moments) – Blanchot says:
‘I know – do I know it – that the one at whom the Germans were already aiming, awaiting but the final order, experienced then a feeling of extraordinary lightness, a sort of beatitude (nothing happy, however) – sovereign elation? The encounter of death with death?
(Blanchot 2000, 5).
‘The encounter of death with death’. Very interesting. Very chilling to consider the very moment of death being upon one! Using Derrida’s analysis helpfully included in the same volume as the story, we can surmise that this young man is Blanchot as, at the very beginning of the story, Blanchot writes: ‘I remember a young man – a man still young – prevented from dying by death itself – and perhaps the error of injustice.’ (ibid 2000, 3) The man is still young because this is where his ‘self’ died (yet lives on in his absence) and Blanchot is writing about this instance from a position of absence (temporally displaced, if you will): a presence filled by absence; the young man is Blanchot’s self, who is ‘still young’ (lives on) yet has died in that he is only to be associated with Blanchot in the third person (a tenuous link – but still a link – to Blanchot). The narrator is Blanchot ‘now’ or Blanchot without Blanchot; the dead Blanchot, still living; the un-dead Blanchot? He is writing in the third person to signify the death, which is possible because his (corporeal) death was prevented: there exists the same body but a different ‘I’, one that is defined by the fracture. I think that’s followable! It’s rather difficult to communicate such a complicated process. It is difficult to comprehend what that patient must be feeling simply because he had received something that had taken root inside of him in order to give him life. I think it’s all the more powerful when you consider it as comparable to being in front of a firing squad.
Anyway, after preparing for death, he encountered an ‘extraordinary lightness, a sort of beatitude (nothing happy, however) – sovereign elation?’ (ibid, 5) that has similarities with the patient’s experience above. We might paraphrase the patient from Wainwright and Wynne’s project and say that Blanchot had ‘totally acclimatised himself to the fact he was going to die’ and ‘accepted his situation’ and, upon finding that his death was to be postponed, asked himself ‘what do I do now?’ Similarly, we could say that the patient, having been led to the hospital by his diseased heart, became convinced that his death was imminent and was just ‘awaiting but the final order’ where his heart would cease beating then, when a donor became available, the threat was removed and he went hiding in ‘the dense forest’ (ibid, 5) which, for the patient, caused the psychiatrist to be called.
Indeed, the situations are different but nevertheless the same in that there is the robbing of that instant of death on both occasions: the patient had effectively been provoked into killing himself off by acclimatising to his death; Blanchot did the same. Although the death itself remains empirically absent, there exists the trace of it having already occurred in the narrator’s questioning of the ‘encounter of death with death’ or the narrator’s utterance: ‘”I am alive. No, you are dead”’ (ibid, 9) and the patient’s behaviour that prompted the staff to call the psychiatrist. In another (infinitely more complex!) volume, The Writing of the Disaster, Blanchot asserts:
‘The disaster does not put me into question, but annuls the question, makes it disappear’ as if along with the question, ‘I’ too disappeared in the disaster which never appears. The fact of disappearing is, precisely, not a fact, not an event: it does not happen, not only because there is no ‘I’ to undergo the experience, but because (and this is exactly what presupposition means), since the disaster always takes place after having taken place, there cannot possibly be any experience of it.’
(Blanchot 1995, 28)
Indeed, one might say that The Instant of My Death and the patient’s experience in Wainwright and Wynne’s project are dramatisations of that. So a successful transplant can be a disaster at the same time as a success? Of course, there are many people who had transplants who are not thinking ‘Bloody hell! I’ll have to live longer now!’ but are actually rather happy about their transplants. I would still argue that a disaster has taken place, though, as an ‘I’ has been disrupted. I suppose it could be akin to a city being built up again to be better and stronger after an earthquake had decimated it.
Another patient interviewed by Wainwright and Wynne for their DVD says: ‘my personality and character had gone’. And another that she ‘emerged changed; fractured and put back together again’ (Wainwright and Wynne 2008 – 2009, 26) and both seem to resonate with Blanchot to varying degrees. An ‘I’ is lost and identity is pieced together again. In fact, one could go as far as to say that the new ‘I’ constructed from the fragments is other, even more significant, I think, when there is literally an other inside of oneself. This may not necessarily negate the fact that so many patients, upon finding an extended life, find a new-found enthusiasm for life. This is to be contrasted with Blanchot’s being ‘lost’ but both types of experience are an alteration following the initial displacement, disruption, and effective destruction of the ‘I’.
In considering these ‘displaced Is’, it is interesting to consider something I came across in an article by Lesley Sharp (1995, 372) who points out that ‘[many patients] celebrate the day of their transplant as a “second birthday” or “re-birthday” (complete with a cake shaped like the organ).’!
A little on the ‘other’ in the self: after the operation, the required immune-suppressive medication ensures that the self being ‘complete’ in any way is always in abeyance: an Other is introduced to the body, quite literally, and one is reminded about this each time one takes the medication: in a sense, the Other needs taming. After the displacement of the ‘I’, the Other wrestles (both medically and figuratively) for space in the void opened up inside the chest. As Blanchot writes in his 1988 essay Do Not Forget: ‘[w]e think we respect others by grudgingly leaving room for them, but others demand (without demanding) all the room’ (Blanchot 1988 in Holland 1995, 245). In the case of bodily transplant, this seems as true inside the body as it is outside in the ‘real world’, facing ‘real’ others.
So, the question of survival is a difficult one; not just a consideration of whether one lives or dies.
I do hope that isn’t too heavy and was of some interest!
Paul William Craddock