This month my dear friend died from cancer, leaving behind a young family. A continent apart, we talked about her illness and what it meant. She told me that she wasn’t afraid of dying and I believed her because she knew the rich legacy she had created. But in the aftermath of her death a post her daughter released tore me asunder. In it, my friend recalls the reaction of strangers to her illness.
“How could you contract this disgusting illness?” one wailed. “You could easily have another five years,” shrugged another. (She just made it past one.) An acquaintance was angry at not having been told sooner. Another was perplexed by her equanimity, leading to an ambush at the elevator: “You know this is terminal, right?” Someone wanted to know the exact site of cancer. Another recalled the relative of a relative who died of exactly that kind of cancer not so long ago.
My friend’s tone contained calm and a dry wit, but the hurt was palpable. If I am sick, it asked, what good does it do to remind me of my plight? I want to give her a hug of apology but it’s too late. Also, what would I say? That when someone is confronted with a serious illness, we humans can’t resist being thoughtless, intrusive and speculative?
It’s in the context of this loss that I’ve found myself drawn to the public commentary around the German chancellor, Angela Merkel, who has experienced three episodes of tremors at public events. The tremors have surfaced suddenly, she has tried to control them with dignity and poise and persevered at the function. Her staff have blamed dehydration. She herself has hinted that things might take time to settle and has shown insight in stating that she hopes her health will permit her to work while she puts into place plans for her succession. The protective German public has largely granted her privacy.
But this hasn’t stopped the world’s media from not simply reporting her tremors but also zooming in on her shaking hands and unreadable expression while asking doctors to hazard a guess at the diagnosis. A woman in her 60s working extremely long hours in a demanding role at a challenging time develops an episodic tremor while standing in the heat. What’s wrong with her? Dehydration or Parkinson’s disease? Deep fear or multiple sclerosis? Raging sepsis or dementia? This ridiculous question would rightly be thrown out of a medical curriculum because any reasonable clinician would insist on the need for a detailed history and examination followed by appropriate tests and often further observation before pronouncing a diagnosis, especially one with serious consequences for the patient and family. So why the rush to diagnose Merkel from television footage?
We would like to think it’s in the public interest. After all, my dear friend, for all her troubles, only left behind hundreds of grieving family and friends, and some of my patients die such a lonely death that the council has to bury them. Merkel is one of the most consequential leaders in the world today so, if she sneezes, perhaps we all fear catching a cold. But if we were to be really honest, we might care to admit that when we see her shake we are not suddenly concerned about the plight of refugees, climate policy or global stability as much as we are mindlessly curious to know what on earth could be going on. I use the word “mindless” deliberately. Recently I told a patient that her cancer had metastasised to the brain and hence her prognosis was guarded. The next day she was sobbing on the phone, distraught by a throwaway remark that she looked far too well to be dying from brain cancer. That one mindless utterance set into motion indescribably sad and weighty emotions in the mind of one who had many other priorities. Surely, we can do better by our fellow travellers.
The public interest argument has essentially drawn a long bow between Merkel’s tremor and looming neurological decline. If this were true, we ought to be similarly concerned about the impact of a late-night Twitter tirade, a wild night of drinking or an extramarital affair on the ability of world leaders to make good decisions. After all, obesity, hypertension, alcoholism, lack of sleep, confabulation, lack of fitness, stroke and prostate cancer can be more consequential than a tremor. It’s just that they are silent, out of the view of cameras.
It’s also worth asking: could we (again) be holding a woman to a different standard?
Australians overlooked the philandering of Bob Hawke but saw fit to denigrate the country’s only female prime minister, Julia Gillard, by joking about her breasts, buttocks and “barrenness” during a particularly low point in politics. The New Zealand prime minister Helen Clark was similarly hounded for her looks, clothes and sexuality owing to her “self-imposed childlessness”.
If Merkel were to look to a male leader for inspiration, where would she go? Indeed, there is a rich tradition of male world leaders concealing serious maladies from the public. Franklin D Roosevelt’s polio-induced paralysis and dependence on a wheelchair was not public knowledge during his four terms in office. Ronald Reagan’s physicians denied it but many, including his family, suspected early signs of dementia when he was president. François Mitterrand received treatment for metastatic prostate cancer for many years in office and was deemed medically unfit to govern in the last six months because he was too exhausted to focus. The medical bulletins declared him fine while his doctors improvised ways to hang drips among coat stands. Winston Churchill suffered crippling periods of depression and wouldn’t stand too close to express trains, wary of the result of “a few drops of desperation”. It’s easier to find videos of Boris Yeltsin’s drunken escapades than political contributions, but Abdelaziz Bouteflika of Algeria leads the field by clinging to office for two decades without being seen for six years after suffering a stroke. Massive street protests forced him to resign amid questions as to whether he was even alive.
Could a female leader have survived any of these things? Would we brook a female leader whose depression tied her to her bed on many mornings, who needed cancer treatment between summit meetings or had a serious drinking problem that just occasionally saw her wandering the street unclothed?
Angela Merkel is a global figure but she is also a human being who deserves dignity and understanding, not prurient interest. People with an unfolding or unclear illness need space to digest things. If this turns out to be something that affects her capacity to govern, we should then expect her and her physicians to act with integrity and share the relevant details without baring every aspect of her private life. Until then, we diminish ourselves through gossip and speculation.
I have seen through the eyes of my patients the destructive toll of dealing with uninformed commentary about illness, self-limiting or serious. All I can say is that it affects the individual long after everyone else has moved on, and it behoves us to tread lightly. I am happy to sit out the medical pop quiz about what’s wrong with Merkel. I will wait for her to tell us.
• Ranjana Srivastava is an Australian oncologist, award-winning author and Fulbright scholar. Her latest book is called A Better Death