In Slaughterhouse-Five, the masterpiece by Kurt Vonnegut (from our own Iowa Writer’s Workshop), the protagonist Billy Pilgrim used the phrase, “So it goes,” repeatedly when considering various traumas including the incredible horrors of war. Much has been written about what Billy, and hence Mr. Vonnegut, really meant by this phrase. I will not weigh in on this debate, but instead reflect on what this phrase means to me.
As I move through my life (in a more linear fashion than Billy Pilgrim, for those of you who recall the Slaughterhouse-Five story), “so it goes” comes mind when I am faced with a negative outcome that I can not change and that is grounded in the randomness of life. I do not use this phrase as an excuse to avoid next steps, but to help me acknowledge the need to move on.
I have had two very different “so it goes” moments recently.
The first “so it goes” moment involved a grant submission I sent to the National Cancer Institute based on research our team is conducting, exploring how anti-cancer antibodies work in patients with lymphoma. I was very excited about this project when I wrote the grant. As is the case with all such grants, it was evaluated by a peer-review panel who assessed its merit compared to other grants and prioritized it for funding. Two of the reviewers thought the proposal was worth considering, but a third did not. Given how competitive NCI grant funding is these days, this was enough to sink the proposal. I am a big fan of the peer-review system, yet it was hard to accept when it resulted in a negative decision for my own proposal. At first I was angry and frustrated by the review and outcome. However, I will not let this stop me from moving forward. Indeed, this type of rejection is faced by close to 90 percent of grants submitted to the NCI by cancer researchers. So … I am doing what many of my colleagues are doing, and using the critique provided by the panel to think about next steps. It would have been great if this grant had been funded, but that was not to be. So it goes.
The second “so it goes” moment involved a patient I have known for many years. During this time, I have had many conversations with this patient and her family about her malignancy, options for therapy, and indeed about her life in general. I have grown to like and respect this wonderful family. Unfortunately, her malignancy has gotten to the point where additional therapy with curative intent is not feasible, and it is time to focus on quality of life. This is a very difficult transition for the patient, for her family and for me, but it is the best choice at this point in time. So it goes.
There is a major difference between Billy Pilgrim’s view on war as reflected by “so it goes,” and my view on cancer. Billy says “so it goes” when he views war as inevitable and impossible to win. The same is not true with cancer. If we can press on with research efforts, such as those outlined in my “so it goes” research moment, they will lead to fewer “so it goes” patient moments.
A recurring theme in Kurt Vonnegut’s writings is the randomness of life, but he did not focus only on the negative. He also said, “Notice when you are happy, and exclaim or murmur or think at some point, ‘If this isn’t nice, I don’t know what is.’” I try to say this to myself when good things happen to me and my patients. In recognition of the randomness of life and that fact that none of us know what tomorrow may bring, I follow this with a “So it goes.”