In classic Aristotelian drama, there comes a moment when the main character is presented with an insurmountable obstacle, be it physical, psychological, spiritual, or otherwise. The nature of the obstacle forces the character to make a choice: a critical choice, an act of free will that determines the glide path of the rest of the story, irrevocably altering its arc.

So it is with the arc of illness, a medical drama wherein a patient is the protagonist, and his or her Aristotelian-type critical choice has consequences that determine not only that patient’s ultimate response to illness, but what that illness means.

Nemesis, a new novel by Philip Roth—passed over again for the Nobel Prize in literature; what are they waiting for?—involves precisely such a choice. It is a tender yet dispiriting story that illustrates how the meaning of human illness is not so much passively sought as it is actively wrought. Patients, Roth shows us, both discover and determine the meaning of the illnesses that afflict them.

For an excellent, in-depth book review of this novel, I refer you to the October 15 post by D.G. Myers on his fine literary commentary site, A Commonplace Blog.

The story’s protagonist is 23-year-old Bucky Cantor, a Newark (Roth’s favorite stomping ground) physical education teacher of superior physical strength and personal decency. Bucky, whose poor vision has kept him out of WWII, is engaged to a woman he loves and greatly fulfilled by his summer job of playground director at a school in the Jewish section of 1944 Newark, which is in the midst of a polio epidemic.

At first appearing immune while countless around him fall stricken and paralyzed, Bucky, too, eventually contracts polio, leaving him—a former college Javelin thrower—with a dangling, atrophied hand and a frail leg that causes him to hobble where he once strode with manly purpose.

It is at this point in the arc of his illness that Bucky confronts his Aristotelian moment, a critical choice that will determine his response to illness and bestow it with meaning. Unhappily, he blames God for infecting him, and himself for infecting others. He ends his engagement, quits teaching, and goes to work at the post office, choosing to live a joyless, solitary life out of anger, guilt, or both. Years later, when asked about his once-betrothed and whatever husband she might have chosen in place of him, Bucky has this to say: “Let’s hope their merciful God will have blessed them…before He sticks His shiv in their back.”

It needn’t be this way.

I have had the pleasure of meeting a young man who, when faced with a medical catastrophe of equally dire proportions—end stage kidney disease—bestowed a very different meaning on his illness than did the fictional Bucky. His name is Shad Ireland, and he is the first dialysis patient to have ever completed a true Ironman triathlon: a 2.4-mile swim, 112-mile bike race, and 26.2-mile marathon run.

Consecutively. As in, with no rest in between. Can you imagine? A dialysis patient doing an Ironman? Are you kidding me?

In Shad’s own words, from an article in the January 2008 issue of aakpRENALIFE, the journal of the American Association of Kidney Patients, “People should know that they are more than their diagnosis. A person’s attitude toward their illness has a huge impact, not just on what they can achieve, but on their total quality of life … My motto is ‘No limitations, only inspiration.”’

Aristotle could not have put it any better.

Richard Barager is a nephrologist who blogs at his self-titled site, Richard Barager.

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