In the period just before she entered hospice, I heard Laura ask visitors if they’d heard about the “three kiss-offs” she’d received from her doctors. An earlier post describes the meetings when her surgeon, radiation oncologist, and oncologist told her that there was nothing more they could do for her,.
As I’ve said about many of Laura’s statements, I could be really thick at times. When I first heard her mention the “three kiss-offs,” I questioned to myself whether the radiation oncologist, at least, might not have seemed more caring than Laura’s words implied. Even more I was afraid that the “three kiss-offs” expressed and reinforced Laura’s feeling negatively about herself. Over time I’ve come to realize that far from accepting rejection, Laura stood up for herself to the end. The only negative judgment in the “three kiss-offs” concerns the doctors. She saw through the practiced hug I thought was kind. In the years since, I’ve come to see that the “three kiss-offs” also reflects how I feel about the entire course of her treatment before the clinical trial at NCI and hospice. The three posts subtitled “backstory” present the most pertinent incidents behind our feelings.
The important point about the “three kiss-offs” phrase is not how accurately it describes what actually happened in those closing meetings with the physicians, nor even over the entire course of Laura’s treatment. Just as my first concern was how this phrase might affect Laura’s perception of herself in the face of the failure of treatment, so my ultimate interest after a few years of working through my denseness involves the way this phrase expresses how Laura actually handled her situation Given her worsening aphasia, she had few verbal resources at her command by this time. The phrase “three kiss-offs,” therefore, worked in place of long conversations or written interchanges with others to process what was going on and how she felt about it. But who knows what exchanges were going on in her head? She may have been able only to say her piece in three words, but aphasia did not impair the thinking of a woman who was both a literary scholar and a lawyer.
Aphasia robbed Laura and me of the opportunity to talk about what would happen when she was gone. I’m not going to attempt the maudlin exercise of imagining such a conversation. But, in the case of the “three kiss-offs,” I am going to offer a deeper analysis of what this phrase says about how Laura thought and felt about her treatment. I make no claim that what follows represents what Laura actually thought, but I do offer it as a framework for subsequent posts about ways people handle pain, suffering, and illness, just as Laura used “the three kiss-offs” to handle her situation.
I see “three kiss-offs” as functioning in two ways for Laura: imagining and ordering. Given my preference for verbs over nouns, I am adapting two key concepts for which Carol Newsom uses nouns in her study The Book of Job: a Contest of Moral Imaginations. The first occurs in the title, moral imaginations. The second addresses a key question in the story of Job: moral order. While I acknowledge my debt to Dr. Newsom for these concepts, I emphasize that translating them from categories into activities changes them, as much as I have tried to stay on the path of her original insights. I do not mean to imply, however, that Newsom’s approach to Job is rigid or static. She fully analyzes the dynamics of the Book of Job as a dialogue, or as the title states a “contest.”
When we imagine, we do more than just develop ideas, even complex, nuanced ideas. Rather, we move from feeling to judging as we interpret and value what is happening to us and what we are going to do about it. Happening and doing are what make this imagining moral. We engage in activities like telling stories, making comparisons, using words to make pictures, “and many other such devices” Each of the ways we imagine morally invites our audience to participate as we frame the world in particular ways, and each evokes “patterns of response to misfortune that are incontrovertible, so long as one moves within the logic of the metaphor.” Imagining morally is less about “what someone says” and more about “how she says it.” [Newsom (Job) 262-3]
In the “three kiss-offs” Laura engages us in a potent image of abandonment, dismissal, and rejection by a loved one. As I have noted before, Laura’s father is a retired physician, whom she loved as a father and respected as a physician. Some incidents during her treatment violated how she imagined caring physicians like her father would act.
Using the substantive categories of the nouns “imagination” and “order,” Newsom identifies the attributes of “the social and moral order one encounters in biblical traditions” as including hierarchy, power, differences in power, father, patron distributing benefits, kin (“real and fictive”), shame, and purity. This moral order limits abuse of power through “moral formation and social sanction,” while it affirms “a common humanity and belief in one God who made all.” [Newsom (Job) 123]
In order to translate the noun phrase “moral order” even more thoroughly into the verb “to order morally,” and to distinguish moral ordering from imagining morally, I’m going to borrow Jean Piaget’s distinction between “two aspects of thinking that are different, although complementary” in the development of children: figurative and operative.
The figurative aspect, which includes perceiving and imagining, imitates “states taken as momentary and static.” The operative aspect includes actions “which transform objects or states,” and intellectual operations, which can be reversed and carried out internally by representing actions without actually doing the actions. In other words, the operative aspect “deals not with states but with transformations from one state to another.” Avoiding the substance-philosophy understanding of change as movement from one fixed state to another, Piaget emphasizes that “any state can be understood only as the result of certain transformations or as the point of departure for other transformations.” (Piaget 14)
Ordering, Piaget notes, arises not out of the objects being acted upon, but out of the activities themselves. When we order, we coordinate activities in various ways such as joining them together, doing them in succession, matching one activity with another, or intersecting activities. (Piaget 18) What Newsom calls “moral orders” constitute these coordinated activities as practices and expectations embedded and embodied in our recurring patterns of social interaction.
For Laura the “three kiss-offs” does not point to violation of an expectation of success through skill, but the expectation of caring. At the outset Laura questioned the justice of her illness in the context of the healthy life she led. But the “three kiss-offs” was not about expecting that she was somehow owed a cure. No, she expected continuing care even as cure slipped away. I did not want to press a sore spot with her so I never told her how I felt about being let loose to find a clinical trial on my own with only a web site address to get started. As in other matters, we may not have talked and she may not have been able to put everything into words, but as I will relate in a later post she was very much aware of the process of finding a clinical trial. She was not only aware, she morally ordered this process in terms of caring and loving.
But that’s another story. The “three kiss-offs” reminds me more of Job’s rage for order in his speech in Chapters 29 through 31. As the title for this post, I have selected one of Job’s lines that seems most reminiscent of Laura’s intent.
They abhor me, they keep aloof from me;
they do not hesitate to spit at the sight of me.
Because God has loosed my bowstring and humbled me,
they have cast off restraint in my presence. Job 30:10-11 (NRSV)
Job’s phrase “spit at the sight of me” pictures rejection (“keep aloof from me”) in terms of a bodily function that not only expresses contempt, but also is almost always morally disgusting in whatever context it occurs. Laura’s phrase presents another bodily function that is normally pleasant, but in the context in which this function is misappropriated, even abused, to dismiss someone instead of embracing them.
Laura doubles the irony implicit in “kiss-off” by applying it to three professional relationships when both a kiss and a kiss-off are so intimately personal. Her sarcasm reminds me of another process of moral ordering that Carol Newsom calls “counter-discourse” in her work The Self as Symbolic Space: Constructing Identity and Community at Qumran.
Newsom describes the “dominant discourse” as “the practices of the establishment … what those in power expect and require and receive, both in material terms and in symbolic attitudinal terms.”
In a paradoxical way the dominant discourse can be identified as precisely what goes without saying. It is what everybody knows, what does not have to be specified, what is thoroughly internalized, so that it is produced and reproduced without much fanfare.
The discourse dominating Laura’s farewell meetings with her doctors was professionalism, sticking to the facts and to what steps come next without letting emotions interfere.
Two other contemporary examples of dominant discourse relevant to this discussion are “positive thinking” and the “Pink Ribbon Culture” surrounding breast cancer. Barbara Ehrenreich describes and criticizes the first in Bright-Sided: How the Relentless Promotion of Positive Thinking Has Undermined America. Gayle Sulik does the same work for the second in Pink Ribbon Blues: How Breast Cancer Culture Undermines Women’s Health. The color pink and the ubiquitous pink ribbons present the moral imagining dimension of this discourse. Pink Ribbon Culture also does its moral ordering through “feeling rules,” which are described by Sulik (230) as:
#1 optimism: normalize the experience, don’t complain, get empowered
#2 male selfishness over female selflessness
#3 guilt if don’t act as she-ro
Uniting modern medicine and the cancer industry within a cultural system that would promote medical consumerism in tandem with hopeful communities of survivorship, pink ribbon culture created a new archetype for diagnosed women. … Cultivating the belief in early detection, faith in the medical system, and a fervent commitment to medical consumerism, the triumphant survivor (she-ro) would promote medical surveillance and intervention with renewed hope for a future without breast cancer. (Sulik 158)
“Counter-discourse” overturns “something that the dominant discourse takes for granted.” Often it is not in direct opposition, but it always interrupts and disrupts. In her sly question about the “three kiss-offs,” Laura’s highly emotional image “disturbs the smooth flow of what everyone takes for granted and in so doing calls attention” to what she is saying “and gains a measure of cultural power by doing so.” [Newsom (Qumran) 17-18]
The relatively disadvantaged know that by modifying the discourse or disrupting it and making it problematic they can secure attention, influence, and other benefits. The struggle for meaning is paramount, because where meaning goes, power follows. [Newsom (Qumran) 19]
Gayle Sulik’s book presents a number of case studies of women with breast cancer engaging in their own forms of counter-discourse, imagining their own stories outside the pink paradigm and ordering their lives on their own terms. Barbara Ehrenreich’s chapter on her own experience with breast cancer has a retort that is almost as pithy as Laura’s:
I didn’t mind dying, but the idea that I should do so while clutching a teddy and with a sweet little smile on my face—well, no amount of philosophy had prepared me for that. Ehrenreich 17
Laura had lost out in the struggle to stop her tumor, aphasia took her voice, the visual cut took her sight, but very quietly, in just three words, Laura interrupted the veneer of professionalism, asserting her meaning for what was happening and her power to shape for others what was going on. I have emphasized how Laura’s image conveyed a feeling of violation and injured love, but by asking her visitors if they’d heard about the “three kiss-offs” she was also inviting them to laugh at the absurdity of professional behavior. Like Ehrenreich’s quip, Laura’s sardonic question disrupted the message that I had feared those in power were sending her.
These reflections now make me realize what I was doing with friends and visitors during the last month of Laura’s life. I made it a point of telling them that one of Laura’s dying wishes was that we get a new refrigerator, which she did thanks to the efforts of our friend Louise Lutz. I took silent pleasure in watching the expressions on their faces as they suppressed the urge to look shocked or quizzical. Because that refrigerator was very important to Laura, it was very important to me, and we were both deeply grateful to Louise. If I really felt that way, why did I seem to be inviting derision for wanting a refrigerator as death approached? I can see now that I was doing my own bit of counter-discourse, in this case, against the dominant expectation that only high-minded subjects should be considered during the process of dying. In my small way I was disrupting the normal discourse about a process over which I had no control. At least I could throw a monkey wrench into the social machinery around the process of dying.