Cause of Death
Beth Anne Macdonald
Creative Nonfiction
Things we say about the dead.
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“Everything happens for a reason.”
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“She’s in a better place now.”
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“At least their suffering is over.”
My personal favorite: God needed another angel in heaven. In this theory, The Almighty looks down upon us from his celestial throne and ranks us, taking only the very best for himself. God presses the Golden Buzzer and you get promoted to angel.
No one ever says, “If only she hadn’t been a Fundamentalist Christian, she might still be alive.” But maybe we should.
death cer·tif·i·cate | deTH ˌsərˈtifəkāt |
noun
A permanent record of an individual’s cause-of-death.
The Centers for Disease Control and Prevention considers the death certificate a document of considerable consequence. They make this explicit on the form itself:
Instructions for Completing the Cause-of-Death Section of the Death Certificate
Accurate cause-of-death information is important:
• To the public health community in evaluating and improving the health of all citizens,
• Often to the family, now and in the future, and to the person settling the decedent’s estate.
The cause-of-death section consists of two parts. Part I is for reporting a chain of events leading directly to death, with the immediate cause of death (the final disease, injury, or complication directly causing death) on Line A and the underlying cause of death (the disease or injury that initiated the chain of morbid events that led directly and inevitably to death) on the lowest used line. Part II is for reporting all other significant diseases, conditions, or injuries that contributed to death but which did not result in the underlying cause of death given in Part I. The cause-of-death information should be YOUR best medical OPINION. A condition can be listed as “probable” even if it has not been definitively diagnosed.
On my mother’s death certificate, the immediate cause of death is handwritten in block letters.
DEATH WAS CAUSED BY APPROXIMATE INTERVAL BETWEEN ONSET AND DEATH
PART 1. IMMEDIATE CAUSE:
METASTATIC BREAST CANCER 2 YEARS
me·tas·ta·sis | məˈtastəsəs |
noun
The spread of a disease-producing agency from the initial or primary site of disease to another part of the body.
Metastatic Breast Cancer: A distilled version of the truth reduced to three words. Distilled to a version of truth not entirely accurate.
There are two sections below this:
DUE TO OR AS A CONSEQUENCE OF:
(B)
DUE TO OR AS A CONSEQUENCE OF:
(C)
And below that:
PART II. OTHER SIGNIFICANT CONDITIONS CONTRIBUTING TO DEATH BUT NOT RELATED TO CAUSE GIVEN IN PART 1(A):
CDC INSTRUCTIONS: PART II (OTHER SIGNIFICANT CONDITIONS) • ENTER ALL DISEASES OR CONDITIONS CONTRIBUTING TO DEATH THAT WERE NOT REPORTED IN THE CHAIN OF EVENTS IN PART I AND THAT DID NOT RESULT IN THE UNDERLYING CAUSE OF DEATH. SEE EXAMPLES.
These sections are all blank on my mother’s form; no other underlying or significant conditions—comorbidity factors—having been identified.
co·mor·bid·i·ty | ˌkōmôrˈbidədē |
noun
The presence and effect of one or more conditions other than the primary condition. A comorbidity can be physiological or psychological.
In fact, the immediate cause of death was Respiratory Arrest. I know this because, unlike her oncologist, I was there. My mother stopped breathing when she was removed from the ventilator that was keeping her alive. I’m curious, too, about the two-year interval noted between onset and death. My mother was first diagnosed with breast cancer in 1985. The second time in 1996. Neither event is recorded by her oncologist as instructed by the CDC. She died in 2005, making 2003 the year of metastasis according to the last record we will ever have.
What might the justification be for the lack of detail afforded my mother by her oncologist in this last official document? Its inaccuracies change nothing, I suppose. Perhaps he was too busy to pay attention. Yet, I am left to wonder about the quality of care he provided to her in life. Left to wonder if he was another man, one of so many, who couldn’t be bothered with genuinely seeing her.
If the cause of death is important to the public health community in evaluating and improving the health of all citizens, the etiology and progression of my mother’s cancer is important.
e·ti·ol·o·gy | ˌēdēˈäləjē |
noun
The cause, set of causes, or manner of causation of a disease or condition.
It is a curious thing, a death certificate. The bookend to the birth certificate, the first certificate we receive just for showing up. If a birth certificate symbolizes the beginning of potential, then a death certificate symbolizes its end. What we say and what we believe to be true about a person’s cause of death reveals much about what we thought of their life.
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If you asked those who knew my mother longest and best, they would say with mournful confidence, “She died of breast cancer.” They did not need to be experts in death to believe this. My mother was first diagnosed with breast cancer when she was forty-two.
According to science, it is not so surprising that my mother was diagnosed with breast cancer, given that her mother had it before her. Maybe this is a simple story after all. In this version, cancer is a function of heredity. Here, science and theology are not so far apart. Both agree: death traveled through the matriarch.
My mother’s first cancer diagnosis came after the birth of my brother, near the onset of his childhood epilepsy. Given my mother’s age, my parents considered my brother a miracle baby, ordained by God. A miracle, despite my mother providing all the financial stability in our precarious household, my father having slipped into a world of madness and religious delusions.
Our family mantra: God will provide. Followed closely by: God never gives you more than you can handle. I find that this is often said of terrible things that affect women and children especially. Or women say it to themselves, ersatz consolation for the terrible things over which they have no control, often rendered unto them by men. What it means: Don’t question your circumstance.
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Her second breast cancer diagnosis would come just over ten years later, along with a cascade of associated health issues. Eventually, metastatic breast cancer became the immediate cause of death, according to that attentive oncologist. Given the statistics around recurrence, it is even less surprising that she received the second diagnosis, that she died at sixty-two.
What is not accounted for in any statistic or three-word distillation on a death certificate is circumstance. Other significant conditions. Her recurrence came at a time when she was far from home, living on a boat with my father, homeschooling her now middle-school-aged miracle, and preparing to continue a fool’s journey to Guatemala after being rescued by the Coast Guard off the coast of North Carolina during Hurricane Gordon.
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If you asked her mother-in-law about my mother’s cancer, Betty would have said that my mother got cancer because she didn’t take care of herself. By that, she meant specifically her weight. There was too much of it.
I wonder if, behind her tight-lipped smile and perfectly pressed polyester pantsuit, Betty imagined God, gazing down upon the kitchen table, wagging his finger as my mother scooped an extra spoonful of creamy homemade potato salad onto her plate, admonishing her, “You’re gonna pay for that someday.” God hates many people, including the overweight. So thought my perfectly trim, coiffed, and disturbed grandmother. In this version of the story, cancer is an appropriate sentence for women who let themselves go.
Betty is no longer with us. God needed another angel in heaven.
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If you asked her husband, the only man my mother ever dated, he would tell you (as he has told so many others) that she died from the Sin of Disobedience.
For the wages of sin is death; but the gift of God is eternal life through Jesus Christ our Lord. (Romans 6:23 KJV)
The simple, ridiculous truth of it was that she refused to hand over her 401k as he had demanded, my father who hasn’t held a steady job since 1974, so he could buy a bigger sailboat. God had told my father that the sailboat was necessary to continue His Work. My mother’s refusal was therefore standing in the way of the Will of the Lord. In this version, God gave my mother cancer on purpose.
I am grateful that God didn’t ask my father to make an offering of their miracle baby or I might be an only child again.
And he said, Take now thy son, thine only son Isaac, whom thou lovest, and get thee into the land of Moriah; and offer him there for a burnt offering upon one of the mountains which I will tell thee of. (Genesis 22:2 KJV)
My father eventually got my mother’s 401k, her social security benefits, a bigger sailboat, and a new wife to share it all with. Payment with interest for that rib in the Garden. God has been good to the Son of Adam.
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I do not believe in a God that metes out prize or punishment based on a sacred scorecard. That is Santa’s job. This means that I don’t believe in my family’s version of God at all. This is some serious fucking heresy, and my father assures me I am going straight to Hell. The Bible’s version of history says so. Hell, my final destination as a Daughter of Eve since I was thirteen.
his·to·ry | ˈhist(ə)rē |
noun
The accepted version of the truth.
her·e·sy | ˈherəsē |
noun
A belief contrary to the accepted version of the truth.
What about her friends? All of them Christian. Most from her Church. What stories did they tell? What does friendship look like for a fundamentalist Christian? I’m sure they prayed a lot. Prayed that her husband would be better. That he would have a good day. That God would cure her cancer.
I doubt that they prayed, sitting with hands clasped and heads bowed, repeating “Thy will be done, Lord”, that she would find the strength to leave.
In this version, it was all part of God’s plan.
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To understand the chain of events that led to my mother’s death, we must go back to the origin stories of her childhood. A childhood that, from an early age, instilled the belief that a woman’s dreams and desires, if she dared to have any at all, were always subordinate to the dreams and desires of the male figures in her life. To be sure, what she learned at home originated from the pulpit on Sundays, lessons taught not as parable but as Gospel. Truth absolute.
Wives, submit yourselves unto your own husbands, as unto the Lord.
(Ephesians 5:22 KJV)
To understand her death (and the deaths of so many other mothers, sisters and daughters) we must consider the social conditioning, the cumulative effect of growing up in an insular culture that reinforces “traditional values” based on biblical teachings of woman’s subservience to man due to her inherent sinfulness.
What did she learn as she listened to her mother recount how she gave up her teaching career for the privilege of marriage? What did she learn when her brothers tied her to a tree in the front yard and tormented her with a snake and nothing happened because boys will be boys after all? What did she learn about abuse? About asking for help? When the family sat around the dinner table and her father refused to speak, staring coldly at items until his wife or children passed them to him, what did she learn about hierarchy and male power? About obedience and subservience?
Let the woman learn in silence with all subjection. But I suffer not a woman to teach, nor to usurp authority over the man, but to be in silence. For Adam was first formed, then Eve. And Adam was not deceived, but the woman being deceived was in the transgression.
(1 Timothy 2: 11-14 KJV)
Might we list obedience and subservience as comorbidity factors in my mother’s death? Might we name her parents as complicit in her demise?
com·plic·it | kəmˈplisət |
adjective
Choosing to be involved in a questionable act, especially with others.
And what of me? What was my role as family heretic? Convinced of my inerrancy, what room did I give to her personhood? Instead of demanding she leave, might I have tried listening? Did she think I was condemning her by condemning her choices? Was I as contemptuous of her as the religion I so vehemently despised?
Sometimes, I think I was no better at seeing her than anyone else; that I, too, was an accomplice in her passing. Sometimes, I remember I was drowning too.
What saved me? Divine Intervention? Maybe. Dumb luck? Probably. Perhaps it was the stream of bright red rage flowing in my veins from the generations of women before me. I have faith that I am supposed to be here. But there is also the survivor’s guilt. Even now. I wish I could have saved her, though I know it is impossible to save a person who doesn’t wish to be saved. Who doesn’t even know that they are in danger.
ac·com·plice | əˈkämpləs |
noun
A person who knowingly helps another in wrongdoing.
My mother, fond as she was of our family history, was always content with what she found on the surface. Superficial bloodlines traced easily over a conversation and a cup of tea. To all of my explorations, I think she would have shrugged, dismissive of any causal links between family patterns and family Bible. She knew the consequence of curiosity.
Unto the woman he said, I will greatly multiply thy sorrow and thy conception; in sorrow thou shalt bring forth children; and thy desire shall be to thy husband, and he shall rule over thee. (Genesis 3:16 KJV)
A fundamentalist Christian, my mother believed her marriage and her cancer were her crosses to bear. God’s Will. She believed this of many things in her life. And it is here that we come closest to the true story of her death. Other significant conditions contributing to death but not related to cause given in Part 1 (A).
ma·lig·nant | məˈliɡnənt |
adjective
Tending to produce death or deterioration.
My mother’s cancer was malignant, the cells endlessly mutating and replicating in her body. Her Christianity was malignant too, as was the unrelenting stress of living with an abusive, mentally ill husband. Of staying because she believed it was what she deserved. That was what her family taught her. That was what her church taught her. It was God’s Will. Family and Faith taught her that leaving would displease God. Taught her to suffer gladly and in silence. Family and Faith taught worthiness along gender lines.
In staying, my mother failed to take good care of herself, and she failed to take good care of her children. But she hardly decided to stay, over and over and over again, unsupported. In the view of the world that she was taught, women acquiesce to the good sense and direction of a male God, no matter how much suffering must be endured along the way. A father, husband, brother always knows best. My father’s faith taught him that his malice was acceptable to God. My mother’s faith told her he was right. Her faith did not save her.
gen·e·sis |ˈjenəsəs |
noun
The origin or coming into being of something. The first book of the Bible.
car·cin·o·gen·e·sis |ˌkärs(ə)nəˈjenəsəs |
noun
The production of cancer.
car·cin·o·gen | kärˈsinəj(ə)n, ˈkärs(ə)nəˌjen |
noun
Any substance that promotes carcinogenesis.
I trace the words of Science and Bible over and over in my mind. I always come back to the same conclusion. The genesis in the chain of events that led to my mother’s death was her version of Christianity. In this story, faith is a carcinogen—a malignancy that spreads through the reduction of freedom—of which Patriarchy and misogyny are features not flukes.
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The last words my mother wrote to me on the night she died were, “Help me breathe.”
I’m trying.
Beth Anne Macdonald (she/her) uses her passion for religion and cultural mythmaking along with a distinctly witty, feminist worldview to tell stories and ask questions about what it means to belong. You will find her most recent creative non-fiction work, explorations of genealogy and family storytelling in the Autumn 2022 Anthology from Querencia Press and The Open Sewers Project, Winter 2022 Anthology. You can often find her musing around on Instagram @tiny_distractions.