Cancer Patient Quotes

People talk about the courage of cancer patients, and I do not deny that courage. I had been poked and stabbed and poisoned for years, and still I trod on. But make no mistake: In that moment, I would have been very, very happy to die.

The failure to think positively can weigh on a cancer patient like a second disease.

No one would ever tell a cancer patient to 'just get over it.' Why people think they can tell those with a mental illness as much is baffling.

I got schooled this year. By everyone. By my little brother... by The Avett Brothers... by my mother, my best friend, my teacher, my father, and by a boy. a boy that I'm seriously, deeply, madly, incredibly, and undeniably in love with... I got so schooled this year. By a nine-year-old. He taught me that it's okay to live life a little backwards. And how to laugh At what you would think is un-laughable. I got schooled this year By a Band! They taught me how to find that feeling of feeling again. They taught me how to decide what to be And go be it. I got schooled this year. By a cancer patient. She taught me so much. She's still teaching me so much. She taught me to question. To never regret. She taught me to push my boundaries, Because that's what they're there for. She told me to find a balance between head and heart And then she taught me how... I got schooled this year By a Foster Kid She taught me to respect the hand that I was dealt. And to be grateful I was even dealt a hand. She taught me that family Doesn't have to be blood. Sometimes your family are your friends. I got schooled this year By my teacher He taught me That the points are not the point, The point is poetry... I got schooled this year By my father. He taught me that hero's aren't always invincible And that the magic is within me.. I got schooled this year by a Boy. a boy that I'm seriously, deeply, madly, incredibly, and undeniably in love with. And he taught me the most important thing of all... To put the emphasis On life.

Just as the desperate, terminally ill cancer patient often turns to expensive placebos for an imaginary chance at more life, the desperate, terminally alive sad people turn to expensive placebos for a chance to imagine a decent life.

He also said that if anyone did anything to mess up the rest of the testing, he was going to call 911 personally. Yeah, like that wouldn't make it into the nightly news again: WHEELCHAIR-BOUND CANCER PATIENT ARRESTED FOR FREE SPEECH.

But the story of leukemia--the story of cancer--isn't the story of doctors who struggle and survive, moving from institution to another. It is the story of patients who struggle and survive, moving from on embankment of illness to another. Resilience, inventiveness, and survivorship--qualities often ascribed to great physicians--are reflected qualities, emanating first from those who struggle with illness and only then mirrored by those who treat them. If the history of medicine is told through the stories of doctors, it is because their contributions stand in place of the more substantive heroism of their patients.

We are left wondering why we are having good days, why we are surviving. It is curious that survivor's guilt could befall a cancer patient.

Be careful of using the word normal around cancer patients, whether they call themselves a survivor or not, there is no 'back to normal'.

Studies of cancer patients show that attitudes of mind have very little effect on clinical outcome. We may say we are fighting cancer, but cancer is merely fighting us; we may think we have beaten it, when it has only gone away to regroup. It is all just the universe doing its stuff, and we are the stuff it is being done to. And so, perhaps, with grief. We imagine we have battled against it, been purposeful, overcome sorrow, scrubbed the rust from our soul, when all that has happened is that grief has moved elsewhere, shifted its interest.

Every era casts illness in its own image. Society, like the ultimate psychosomatic patient, matches its medical afflictions to its psychological crises; when a disease touches such a visceral chord, it is often because that chord is already resonating.

It is exhausting explaining over and over again that yes, I am doing great and I feel fantastic, but I still cannot do the things I once did. My new normal with Cancer Related Fatigue.

But if you needed to HAVE AN IDEA, boredom could be to a roadblocked novel what chemotherapy was to a cancer patient.

I’d let the words run over my brain and out my ears, like a terrified cancer patient hearing all that coded jargon and understanding nothing, except that it was very bad news.

Honesty is the best approach - and some understanding of how cancer patients see their illness can help. Cliched terms and thoughtless positives don't work, such as, 'You look good, though.' 'At least you got the good cancer.' 'Be strong.' 'You got this.' 'This is just a season.

Those who take their own lives, especially when the quality of those lives is much less bad than those of the cancer patient or the concentration camp prisoner, fly in the face of the normal will to live. They are seen as abnormal, not merely in the statistical sense of being unusual, but of being defective, either morally or psychologically.

Subjects in the experiments were sometimes unwitting civilians. At other times they were soldiers, prisoners, mental patients, sex offenders, cancer patients and other individuals who were unwitting, or who could not give meaningful informed consent.

To: Anna Oliphant From: Etienne St. Clair Subject: HAPPY CHRISTMAS Have you gotten used to the time difference? Bloody hell,I can't sleep. I'd call,but I don't know if you're awake or doing the family thing or what. The bay fog is so thick that I can't see out my window.But if I could, I am quite certain I'd discover that I'm the only person alive in San Francisco. To: Anna Oliphant From: Etienne St. Clair Subject: I forgot to tell you. Yesterday I saw a guy wearing an Atlanta Film Festival shirt at the hospital.I asked if he knew you,but he didn't.I also met an enormous,hair man in a cheeky Mrs. Claus getup. he was handing out gifts to the cancer patients.Mum took the attached picture. Do I always look so startled? To: Anna Oliphant From: Etienne St. Clair Subject: Are you awake yet? Wake up.Wake up wake up wake up. To: Etienne St. Clair From: Anna Oliphant Subject: re: Are you awake yet? I'm awake! Seany started jumping on my bed,like,three hours ago. We've been opening presents and eating sugar cookies for breakfast. Dad gave me a gold ring shaped like a heart. "For Daddy's sweetheart," he said. As if I'm the type of girl who'd wear a heart-shaped ring. FROM HER FATHER. He gave Seany tons of Star Wars stuff and a rock polishing kit,and I'd much rather have those.I can't beleive Mom invited him here for Christmas. She says it's because their divorce is amicable (um,no) and Seany and I need a father figure in our lives,but all they ever do is fight.This morning it was about my hair.Dad wants me to dye it back, because he thinks I look like a "common prostitute," and Mom wants to re-bleach it.Like either of them has a say. Oops,gotta run.My grandparents just arrived,and Granddad is bellowing for his bonnie lass.That would be me. P.S. Love the picture.Mrs. Claus is totally checking out your butt. And it's Merry Christmas, weirdo. To: Anna Oliphant From: Etienne St. Clair Subject: HAHAHA@ Was it a PROMISE RING? Did your father give you a PROMISE RING? To: Etienne St. Clair From: Anna Oliphant Subject: Re: HAHAHA! I am so not responding to that.

When you get sick you will be surprised by who steps up and who steps away. I can honestly say I did not think this would apply to me. I could not imagine that anyone in my family or circle of friends would not be there for me. Wrong!

Let’s not call cancer patients as patients, they are cancer fighters. They are brave hearts.

To take care of cancer patients is an enormous privilege, but it also involves deploying everything in your toolbox: the emotional, the psychological, the scientific, the epidemiologic.

Leukemia is cancer of the white blood cells—cancer in one of its most explosive, violent incarnations. As one nurse on the wards often liked to remind her patients, with this disease “even a paper cut is an emergency.

I don’t understand hospital chaplains that try to rob my patients of their anger. Sometimes anger is a key motivator that gets people to take action. Anger can push a cancer patient to jump out of his hospital bed, walk down to the nurses station and scream, “I am getting the hell out of here!”. There is a misconception that God is simply sweet and passive. Actually, God can be quite cunning, manipulative and relentless with his children. What we consider as negative traits are actually helpful in molding us. He will use a negative emotion if needed to push people to do things that will change them for the better. He will allow people or situations to derail us if there is a chance that those interactions will push us forward. Personally, I don’t want a God that is going to send some church member to my deathbed with a plate of cookies and tell me to have faith. Actually, I rather have a God that screams, “Get the hell off your ass, stop feeling sorry for yourself. Walk down the hall with that Physical Therapist so you can get on with your life!" A little anger in a person can push them to do amazing things.

I always try to stay positive, but right now I just want to scream and cry a little. I have an amazing support system here, but sometimes I feel like I can't cry or be mad because they think I'm not being positive.

But in 1960, oncology was not yet ready for this proposal. Not until several years later did it strike the board that had fired Li so hastily that the patients he had treated with the prolonged maintenance strategy would never relapse. This strategy--which cost Min Chiu Li his job--resulted in the first chemotherapeutic cure of cancer in adults.

A landmark 2010 study from the Massachusetts General Hospital had even more startling findings. The researchers randomly assigned 151 patients with stage IV lung cancer, like Sara’s, to one of two possible approaches to treatment. Half received usual oncology care. The other half received usual oncology care plus parallel visits with a palliative care specialist. These are specialists in preventing and relieving the suffering of patients, and to see one, no determination of whether they are dying or not is required. If a person has serious, complex illness, palliative specialists are happy to help. The ones in the study discussed with the patients their goals and priorities for if and when their condition worsened. The result: those who saw a palliative care specialist stopped chemotherapy sooner, entered hospice far earlier, experienced less suffering at the end of their lives—and they lived 25 percent longer. In other words, our decision making in medicine has failed so spectacularly that we have reached the point of actively inflicting harm on patients rather than confronting the subject of mortality.

Cancer is a tremendous opportunity to have your face pressed right up against the glass of your mortality.” But what patients see through the glass is not a world outside cancer, but a world taken over by it—cancer reflected endlessly around them like a hall of mirrors.

Top question of the dying: "What made me sick?

I am grateful for everything and every day, and that is no longer just words I feed myself from Post-it notes stuck to my mirror as positive affirmations.

I want you to get remarried after I die.

No,” said a third student. “Novartis is a public company. It’s not the boss or the board who decides. It’s the shareholders. If the board changes its priorities the shareholders will just elect a new board.” “That’s right,” I said. “It’s the shareholders who want this company to spend their money on researching rich people’s illnesses. That’s how they get a good return on their shares.” So there’s nothing wrong with the employees, the boss, or the board, then. “Now, the question is”—I looked at the student who had first suggested the face punching—“who owns the shares in these big pharmaceutical companies?” “Well, it’s the rich.” He shrugged. “No. It’s actually interesting because pharmaceutical shares are very stable. When the stock market goes up and down, or oil prices go up and down, pharma shares keep giving a pretty steady return. Many other kinds of companies’ shares follow the economy—they do better or worse as people go on spending sprees or cut back—but the cancer patients always need treatment. So who owns the shares in these stable companies?” My young audience looked back at me, their faces like one big question mark. “It’s retirement funds.” Silence. “So maybe I don’t have to do any punching, because I will not meet the shareholders. But you will. This weekend, go visit your grandma and punch her in the face. If you feel you need someone to blame and punish, it’s the seniors and their greedy need for stable stocks.

When I went on my first antidepressant it had the side effect of making me fixated on suicide (which is sort of the opposite of what you want). It’s a rare side effect so I switched to something else that did work. Lots of concerned friends and family felt that the first medication’s failure was a clear sign that drugs were not the answer; if they were I would have been fixed. Clearly I wasn’t as sick as I said I was if the medication didn’t work for me. And that sort of makes sense, because when you have cancer the doctor gives you the best medicine and if it doesn’t shrink the tumor immediately then that’s a pretty clear sign you were just faking it for attention. I mean, cancer is a serious, often fatal disease we’ve spent billions of dollars studying and treating so obviously a patient would never have to try multiple drugs, surgeries, radiation, etc., to find what will work specifically for them. And once the cancer sufferer is in remission they’re set for life because once they’ve learned how to not have cancer they should be good. And if they let themselves get cancer again they can just do whatever they did last time. Once you find the right cancer medication you’re pretty much immune from that disease forever. And if you get it again it’s probably just a reaction to too much gluten or not praying correctly. Righ

But in their defense of the supernatural, fundamentalists and their evangelical heirs resemble some cancer patients. In facing a drastic disease, they are willing to undertake a drastic remedy. The treatment of fundamentalism may be said to have succeeded; the patient survived. But at least for the life of the mind, what survived was a patient horribly disfigured by the cure itself.

This was the tenth month of my "fellowship" in oncology - a two-year immersive medical program to train cancer specialists - and I felt as if I had gravitated to my lowest point. In those ten indescribably poignant and difficult months, dozens of patients in my care had died. I felt as if I was slowly becoming inured to the deaths and the desolation - vaccinated against the constant emotional brunt.

Some residents will scoot back inside their rooms, because they think dementia is contagious. Or maybe it’s not, but you never know. Keeping out of the way can’t hurt in any case, is the basic attitude. And that goes not only for dementia. Cancer patients, homosexuals, Muslims: they’re all best avoided.

She could have asked me to do anything, and no matter how heinous, I would have complied. Slaughter a kindergartener? Sure. Scam cancer patients? No problem. Leave a positive review of the new Star Wars movies saying they were better than the originals? I would have smiled while typing. It was sickening.

I think timing is better left up to God to decide then religious leaders. I once met a man that brought his wife flowers in the hospital. They held hands, kissed and were as affectionate as any cute couple could be. They were both in their eighties. I asked them how long they were married. I expected them to tell me fifty years or longer. To my surprise, they said only five years. He then began to explain to me that he was married thirty years to someone that didn’t love him, and then he remarried a second time only to have his second wife die of cancer, two years later. I looked at my patient (his wife) sitting in the wheelchair next to him smiling. She added that she had been widowed two times. Both of her marriages lasted fifteen years. I was curious, so I asked them why they would even bother pursuing love again at their age. He looked at me with astonishment and said, “Do you really think that you stop looking for a soulmate at our age? Do you honestly believe that God would stop caring about how much I needed it still, just because I am nearing the end of my life? No, he left the best for last. I have lived through hell, but if I only get five years of happiness with this woman then it was worth the years of struggle I have been through.

People talk about the courage of cancer patients, and I do not deny that courage. I had been poked and stabbed and poisoned for years, and still I trod on. But make no mistake: In that moment, I would have been very, very happy to die...

Medicine, I said, begins with storytelling. Patients tell stories to describe illness; doctors tell stories to understand it. Science tells its own story to explain diseases.

A patient, long before he becomes the subject of medical scrutiny, is, at first, simply a storyteller, a narrator of suffering—

Specificity refers to the ability of any medicine to discriminate between its intended target and its host. Killing a cancer cell in a test tube is not a particularly difficult task: the chemical world is packed with malevolent poisons that, even in infinitesimal quantities, can dispatch a cancer cell within minutes. The trouble lies in finding a selective poison—a drug that will kill cancer without annihilating the patient. Systemic therapy without specificity is an indiscriminate bomb. For an anticancer poison to become a useful drug, Meyer knew, it needed to be a fantastically nimble knife: sharp enough to kill cancer yet selective enough to spare the patient.

It felt—nearly twenty-five hundred years after Hippocrates had naively coined the overarching term karkinos—that modern oncology was hardly any more sophisticated in its taxonomy of cancer.

terminally ill cancer patients who were put on a mechanical ventilator, given electrical defibrillation or chest compressions, or admitted, near death, to intensive care had a substantially worse quality of life in their last week than those who received no such interventions. And, six months after their death, their caregivers were three times as likely to suffer major depression.

unlike, say, the sun, or the rainbow, or earthquakes, the fascinating world of the very small never came to the notice of primitive peoples. if you think about this for a minute, it's not really surprising.. they had no way of even knowing it was there, and so of course they didn't invent any myths to explain it. it wasn't until the microscope was invented in the sixteenth century that people discovered that ponds and lakes, soil and dust, even our body, teem with tiny living creatures, too small to see, yet too complicated and, in their own way, beautiful, or perhaps frightening, depending on how you think about them. the whole world is made of incredibly tiny things, much too small to be visible to the naked eye - and yet none of the myths or so-called holy books that some people, even now, think were given to us by an all knowing god, mentions them at all. in fact, when you look at those myths and stories, you can see that they don't contain any of the knowledge that science has patiently worked out. they don't tell us how big or how old the universe is; they don't tell us how to treat cancer; they don't explain gravity or the internal combustion engine; they don't tell us about germs, or nuclear fusion, or electricity, or anaesthetics. in fact, unsurprisingly, the stories in holy books don't contain any more information about the world than was known to the primitive people who first started telling them. if these 'holly books' really were written, or dictated, or inspired, by all knowing gods, don't you think it's odd that those gods said nothing about any of these important and useful things?

serves as prevention. Gives physical healing in the body. No matter what name is given to any problem; it will be solved, when the Blood of Jesus is brought in. If you keep pleading the Blood of Jesus, no matter how terrible an infirmity is, it will disappear by the power in the Blood of Jesus. If your life is pure and you lay your hands on any sickness, pleading the Blood of Jesus, it will vanish. You might wonder if it is really as simple as that but that is the Power in the Blood of Jesus. The Power in pleading the Blood of Jesus is yet to be understood by Man. Some people criticise those pleading the Blood of Jesus. It is because they have not passed through the valley, so they cannot know what it means. Someone who has never been tortured by a terminal disease cannot know what it means to be threatened by death, so he or she cannot understand why a cancer patient is praying fervently for healing, or why the person is jubilating after he or she has been miraculously healed. The preachers, who discourage people from praying fire prayers or pleading the Blood of Jesus, do so, because they have not experienced such things. The Blood of Jesus cannot dry up; neither can it lose its power. Therefore you can plead it a million times, if you want to. The more you plead the Blood of Jesus, the more the chance of totally submerging the disease, in the pool of the Blood

In recent years, using tissue samples from themselves, their families, and their patients, scientists had grown cells of all kinds—prostate cancer, appendix, foreskin, even bits of human cornea—often with surprising ease. Researchers were using that growing library of cells to make historic discoveries: that cigarettes caused lung cancer; how X-rays and certain chemicals

My bleep goes off - it’s the morning SHO asking for handover. I’ve spent two hours in this room, the longest I’ve ever spent with a patient who wasn’t under anaesthetic. On the way home I phone my mum to tell her I love her.

Hope is as essential to your life as air and water. You need hope to cope. Dr. Bernie Siegel found he could predict which of his cancer patients would go into remission by asking, “Do you want to live to be one hundred?” Those with a deep sense of life purpose answered yes and were the ones most likely to survive. Hope comes from having a purpose.

Many patients with cancer are depressed, yet depression is not the cause of cancer.

One leukemia doctor wrote, “I know the patients, I know their brothers and sisters, I know their dogs and cats by name.… The pain is that a lot of love affairs end.

It was, I suspected, not the first time that a patient had consoled a doctor about the ineffectuality of his discipline.

It's one thing knowing you people cheering you on, yet another to know they have walked in your footsteps.

If the history of medicine is told through the stories of doctors, it is because their contributions stand in place of the more substantive heroism of their patients. I

Indie authors write, design, sell. Like magic, skip one and you make must read vanish.

many of my patients continued to smoke, often furtively, during their treatment for cancer (I could smell the acrid whiff of tobacco on their clothes as they signed the consent forms for chemotherapy).

Two-thirds of the terminal cancer patients in the Coping with Cancer study reported having had no discussion with their doctors about their goals for end-of-life care, despite being, on average, just four months from death. But the third who did have discussions were far less likely to undergo cardiopulmonary resuscitation or be put on a ventilator or end up in an intensive care unit. Most of them enrolled in hospice. They suffered less, were physically more capable, and were better able, for a longer period, to interact with others. In addition, six months after these patients died, their family members were markedly less likely to experience persistent major depression. In other words, people who had substantive discussions with their doctor about their end-of-life preferences were far more likely to die at peace and in control of their situation and to spare their family anguish.

When a disease insinuates itself so potently into the imagination of an era, it is often because it impinges on an anxiety latent within that imagination. AIDS loomed so large on the 1980s in part because this was a generation inherently haunted by its sexuality and freedom; SARS set off a panic about global spread and contagion at a time when globalism and social contagion were issues simmering nervously in the West. Every era casts illness in its own image. Society, like the ultimate psychosomatic patient, matches its medical afflictions to its psychological crises; when a disease touches such a visceral chord, it is often because that chord is already resonating.

Sickness usually dominates the thoughts of a patient with cancer, but too much preoccupation with illness can have a destructive effect on the mind, and knowing what can happen frequently becomes self-fulfilling. Today, people who are ill will spend hours surfing the internet to find out all they can about their illness – but this isn’t always a good thing.

Today when I see a patient with CML, I tell them that the disease is an indolent leukemia with an excellent prognosis, that they will usually live their functional life span provided they take an oral medicine, Gleevec, for the rest of their lives.

In 2008, the national Coping with Cancer project published a study showing that terminally ill cancer patients who were put on a mechanical ventilator, given electrical defibrillation or chest compressions, or admitted, near death, to intensive care had a substantially worse quality of life in their last week than those who received no such interventions. And, six months after their death, their caregivers were three times as likely to suffer major depression. Spending one’s final days in an I.C.U. because of terminal illness is for most people a kind of failure. You lie on a ventilator, your every organ shutting down, your mind teetering on delirium and permanently beyond realizing that you will never leave this borrowed, fluorescent place. The end comes with no chance for you to have said goodbye or “It’s O.K.” or “I’m sorry” or “I love you.” People have concerns besides simply prolonging their lives. Surveys of patients with terminal illness find that their top priorities include, in addition to avoiding suffering, being with family, having the touch of others, being mentally aware, and not becoming a burden to others. Our system of technological medical care has utterly failed to meet these needs, and the cost of this failure is measured in far more than dollars. The hard question we face, then, is not how we can afford this system’s expense. It is how we can build a health-care system that will actually help dying patients achieve what’s most important to them at the end of their lives.

In an essay titled A View From the Front Line, Jencks described her experience with cancer as like being woken up midflight on a jumbo jet and then thrown out with a parachute into a foreign landscape without a map: "There you are, the future patient, quietly progressing with other passengers toward a distant destination when, astonishingly (Why me?) a large hole opens in the floor next to you. People in white coats appear, help you into a parachute and — no time to think — out you go. "You descend. You hit the ground....But where is the enemy? What is the enemy? What is it up to?...No road. No compass. No map. No training. Is there something you should know and don't? "The white coats are far, far away, strapping others into their parachutes. Occasionally they wave but, even if you ask them, they don't know the answers. They are up there in the Jumbo, involved with parachutes, not map-making.

That’s all very well, but how many family doctors would you need? It simply doesn’t fit into the system of a free universal national health service.” “It’ll fit into a universal national health service, but it won’t fit into a free health service,” said Oreshchenkov, rumbling on and clinging confidently to his point. “But it’s our greatest achievement, the fact that it’s a free service.” “Is this in fact such a great achievement? What does ‘free’ mean? The doctors don’t work for nothing, you know. It only means that they’re paid out of the national budget and the budget is supported by patients. It isn’t free treatment, it’s depersonalized treatment. If a patient kept the money that pays for his treatments, he would have turned the ten roubles he has to spend at the doctor’s over and over in his hands. He could go to the doctor five times over if he really needed to.

The source of racist ideas was not ignorance and hate, but self-interest. The history of racist ideas is the history of powerful policymakers erecting racist policies out of self-interest, then producing racist ideas to defend and rationalize the inequitable effects of their policies, while everyday people consume those racist ideas, which in turn sparks ignorance and hate. Treating ignorance and hate and expecting racism to shrink suddenly seemed like treating a cancer patient’s symptoms and expecting the tumors to shrink. The body politic might feel better momentarily from the treatment—from trying to eradicate hate and ignorance—but as long as the underlying cause remains, the tumors grow, the symptoms return, and inequities spread like cancer cells, threatening the life of the body politic. Educational and moral suasion is not only a failed strategy. It is a suicidal strategy.

Many people assume that terminal patients, especially those with cancer, will have pain. That’s not always so; some have no pain, others have mild to moderate pain that can be controlled with ease. A few people have pain so severe that expert assessment and care are needed to bring it under control.

Perhaps the most fulfilling thing in medicine is sitting with a patient who has been saddled with a chronic disease for years and had lots of concerns about cirrhosis, liver failure, the possibility of having to have a liver transplant, the possibly of developing cancer in the liver, a patient who has fought through a year-long treatment with side effects including sleep disturbances, irritability, a mental fog and being able to tell him, “Mr. Tyler, you’re cured. You don’t need to see me again.

Mihalovic and other critics claim that chemotherapy, in actuality, boosts cancer growth and long-term mortality rates by destroying the immune system, increasing neurocognitive decline, disrupting endocrine functioning, and causing organ and metabolic toxicities. Patients basically live in a permanent state of disease until their death.

In the neighboring town of Carlisle, Lister had observed sewage disposers cleanse their waste with a cheap, sweet-smelling liquid containing carbolic acid. Lister began to apply carbolic acid paste to wounds after surgery. (That he was applying a sewage cleanser to his patients appears not to have struck him as even the slightest bit unusual.) In

Hope is one of our central emotions, but we are often at a loss when asked to define it. Many of us confuse hope with optimism, a prevailing attitude that "things turn out for the best." But hope differs from optimism. Hope does not arise from being told to "Think Positively," or from hearing an overly rosy forecast. Hope, unlike optimism, is rooted in unalloyed reality. Although there is no uniform definition of hope, I found on that seemed to capture what my patients had taught me. Hope is the elevating feeling we experience when we see - in the mind's eye- a path to a better future. Hope acknowledges the significant obstacles and deep pitfalls along that path. True hope has no room for delusion.

A patient suffering with cancer of the throat was informed of a new X-ray machine that would cure his condition. This man could neither read nor write, nor was he informed about any of the instruments or procedures of medical practice. When he first sat down in the doctor's office and received into his mouth a thermometer with which the doctor sought to take his temperature, he believed he was undergoing X-ray treatment. The doctor, alert to the practices of psychology, recognized this, and after leaving the thermometer in the patient's mouth for ten minutes, excused him and told him to return in two days. Three weeks of treatment with a thermometer cured this patient's cancerous condition! Obviously, it wasn't the thermometer that did it. It was Faith!

including salutary effects on the following: • major depression • drug addiction • binge eating • smoking cessation • stress among cancer patients • loneliness among senior citizens • ADHD • asthma • psoriasis • irritable bowel syndrome Studies also indicated that meditation reduced levels of stress hormones, boosted the immune system, made office workers more focused, and improved test scores on the GRE. Apparently mindfulness did everything short of making you able to talk to animals and bend spoons with your mind. This research boom got its start with a Jew-Bu named Jon Kabat-Zinn, a Manhattan-raised, MIT-trained microbiologist who claimed to have had an elaborate epiphany—a “vision,” he called it—while on a retreat in 1979. The substance of the vision was that he could bring meditation to a much broader audience by stripping it of Buddhist metaphysics. Kabat-Zinn designed something called Mindfulness Based Stress Reduction (MBSR), an eight-week course that taught secularized meditation to tens of thousands of people around America and the world. Having a simple, replicable meditation protocol made it easy to test the effects on patients.

Too many people are overly respectful, braying, ‘You’re so brave’ and Irv fell smack into that trap. After all what’s so courageous about having cancer? Once we have it, what choice do we have? But the worst thing of all—and thank God Irv doesn’t do this, at least not yet—is all this nonsensical talk about a patient’s courageous struggle with cancer that all too often ends in defeat. How many obituaries do you see stating that so-and-so lost their courageous battle with cancer? I hate that! I absolutely hate it! If someone put that in my obituary, I’d come back and kill him!

Callahan found that the common first reaction to news of cancer, strokes, heart attacks, or the failure of some major organ was one of betrayal. The patient was astounded to find that such a close (and, up to now at least, fully understood) friend as one’s own body could be so sluggard as to lie down on the job. The reaction which followed close on the heels of the first was the thought that a friend who would let one down so cruelly was not worth having. The conclusion that followed these reactions was that it didn’t matter if this friend was worth having or not. One could not refuse to speak to one’s traitorous body, or get up a petition against it, or pretend that one was not at home when it called. The final thought in this hospital-bed train of reasoning was the hideous possibility that one’s body might not be a friend at all, but an enemy implacably dedicated to destroying the superior force that had used it and abused it ever since the disease of reason set in.

life had been building potential, potential that would now go unrealized. I had planned to do so much, and I had come so close. I was physically debilitated, my imagined future and my personal identity collapsed, and I faced the same existential quandaries my patients faced. The lung cancer diagnosis was confirmed. My carefully planned and hard-won future no longer existed. Death, so familiar to me in my work, was now paying a personal visit. Here we were, finally face-to-face, and yet nothing about it seemed recognizable. Standing at the crossroads where I should have been able to see and follow the footprints of the countless patients I had treated over the years, I saw instead only a blank, a harsh, vacant, gleaming white desert, as if a sandstorm had erased all trace of familiarity.

As a result of its investigation, the NIH said that to qualify for funding, all proposals for research on human subjects had to be approved by review boards—independent bodies made up of professionals and laypeople of diverse races, classes, and backgrounds—to ensure that they met the NIH’s ethics requirements, including detailed informed consent. Scientists said medical research was doomed. In a letter to the editor of Science, one of them warned, “When we are prevented from attempting seemingly innocuous studies of cancer behavior in humans … we may mark 1966 as the year in which all medical progress ceased.” Later that year, a Harvard anesthesiologist named Henry Beecher published a study in the New England Journal of Medicine showing that Southam’s research was only one of hundreds of similarly unethical studies. Beecher published a detailed list of the twenty-two worst offenders, including researchers who’d injected children with hepatitis and others who’d poisoned patients under anesthesia using carbon dioxide. Southam’s study was included as example number 17. Despite scientists’ fears, the ethical crackdown didn’t slow scientific progress. In fact, research flourished. And much of it involved HeLa. 18

Self-centeredness is a havoc-wreaking problem in many marriages, and it is the ever-present enemy of every marriage. It is the cancer in the center of a marriage when it begins, and it has to be dealt with. In Paul’s classic description of love, in 1 Corinthians 13, he says,   Love is patient and kind. It does not envy, it does not boast, is not proud. It is not rude, it is not self-seeking, it is not easily angered, it keeps no record of wrongs. (verses 4–5) Repeatedly Paul shows that love is the very opposite of “self-seeking,” which is literally pursuing one’s own welfare before those of others. Self-centeredness is easily seen in the signs Paul lists: impatience, irritability, a lack of graciousness and kindness in speech, envious brooding on the better situations of others, and holding past injuries and hurts against others.

Oncologists and their patients are bound, it seems, by an intense subatomic force. So, albeit in a much smaller sense, this was a victory for me as well. I sat at Carla’s table and watched her pour a glass of water for herself, unpurified and straight from the sink. She glowed radiantly, her eyes half-closed, as if the compressed autobiography of the last five years were flashing through a private and internal cinema screen. Her

Medical journals from 1905 to 1915 are rife with articles on “vibratory massage” and the many things it cures. Weakened hearts and floating kidneys. Hysterical cramp of the esophagus and catarrh of the inner ear. Deafness, cancer, bad eyesight. And lots and lots of prostate problems. A Dr. Courtney W. Shropshire, writing in 1912, was impressed to note that by means of “a special prostatic applicator, well lubricated, attached to the vibrator, introduced to the rectum” he was “able to empty the seminal vesicles of their secretions.” Indeedy. Shropshire’s patients returned every other day for treatment, no doubt also developing a relationship with the vibration machine.

In 1994, Friedman wrote a memo marked “Very Confidential” to Raymond, Mortimer, and Richard Sackler. The market for cancer pain was significant, Friedman pointed out: four million prescriptions a year. In fact, there were three-quarters of a million prescriptions just for MS Contin. “We believe that the FDA will restrict our initial launch of OxyContin to the Cancer pain market,” Friedman wrote. But what if, over time, the drug extended beyond that? There was a much greater market for other types of pain: back pain, neck pain, arthritis, fibromyalgia. According to the wrestler turned pain doctor John Bonica, one in three Americans was suffering from untreated chronic pain. If that was even somewhat true, it represented an enormous untapped market. What if you could figure out a way to market this new drug, OxyContin, to all those patients? The plan would have to remain secret for the time being, but in his memo to the Sacklers, Friedman confirmed that the intention was “to expand the use of OxyContin beyond Cancer patients to chronic non-malignant pain.” This was a hugely audacious scheme. In the 1940s, Arthur Sackler had watched the introduction of Thorazine. It was a “major” tranquilizer that worked wonders on patients who were psychotic. But the way the Sackler family made its first great fortune was with Arthur’s involvement in marketing the “minor” tranquilizers Librium and Valium. Thorazine was perceived as a heavy-duty solution for a heavy-duty problem, but the market for the drug was naturally limited to people suffering from severe enough conditions to warrant a major tranquilizer. The beauty of the minor tranquilizers was that they were for everyone. The reason those drugs were such a success was that they were pills that you could pop to relieve an extraordinary range of common psychological and emotional ailments. Now Arthur’s brothers and his nephew Richard would make the same pivot with a painkiller: they had enjoyed great success with MS Contin, but it was perceived as a heavy-duty drug for cancer. And cancer was a limited market. If you could figure out a way to market OxyContin not just for cancer but for any sort of pain, the profits would be astronomical. It was “imperative,” Friedman told the Sacklers, “that we establish a literature” to support this kind of positioning. They would suggest OxyContin for “the broadest range of use.” Still, they faced one significant hurdle. Oxycodone is roughly twice as potent as morphine, and as a consequence OxyContin would be a much stronger drug than MS Contin. American doctors still tended to take great care in administering strong opioids because of long-established concerns about the addictiveness of these drugs. For years, proponents of MS Contin had argued that in an end-of-life situation, when someone is in a mortal fight with cancer, it was a bit silly to worry about the patient’s getting hooked on morphine. But if Purdue wanted to market a powerful opioid like OxyContin for less acute, more persistent types of pain, one challenge would be the perception, among physicians, that opioids could be very addictive. If OxyContin was going to achieve its full commercial potential, the Sacklers and Purdue would have to undo that perception.

There are cancers so insidious in their nature that their very pulsation is invisible. Such cancers leave the ivory whiteness of the skin untouched, and marble not the firm, fair flesh, with their blue tints; the physician who bends over the patient's chest hears not, through he listens, the insatiable teeth of the disease grinding its onward progress through the muscles, as the blood flows freely on; the knife has never been able to destroy, and rarely even, temporarily, to discern the rage of these mortal scourges; their home is in the mind, which they corrupt; they fill the whole heart until it breaks. Such, madame, are the cancers, fatal to queens; are you, too, free from their scourge?

Things changed after that between me and Mark. I stopped being mortified that people might mistake me for one of his acolytes. I was his Boswell, don’t you know. I interviewed him about his childhood—his father was a psychiarist in Beverly Hills. I cataloged the contents of his van. I followed him around at work, sitting in while he examined patients. He had been a bit of a prodigy when we were in college. After his father developed a tumor, Mark, who was pre-med, started studying cancer with an intensity that convinced many of his friends that his goal was to find a cure in time to save his father. As it turned out, his father didn’t have cancer. But Mark kept on with his cancer studies. His interest was not in fact in oncology—in finding a cure—but in cancer education and prevention. By the time he entered medical school, he had created, with another student, a series of college courses on cancer and coauthored The Biology of Cancer Sourcebook, the text for a course that was eventually offered to tens of thousands of students. He cowrote a second book, Understanding Cancer, that became a bestselling university text, and he continued to lecture throughout the United States on cancer research, education, and prevention. “The funny thing is, I’m not really interested in cancer,” Mark told me. “I’m interested in people’s response to it. A lot of cancer patients and suvivors report that they never really lived till they got cancer, that it forced them to face things, to experience life more intensely. What you see in family practice is that families just can’t afford to be superficial with each other anymore once someone has cancer. Corny as it sounds, what I’m really interested in is the human spirit—in how people react to stress and adversity. I’m fascinated by the way people fight back, by how they keep fighting their way to the surface.” Mark clawed at the air with his arms. What he was miming was the struggle to reach the surface through the turbulence of a large wave.

ultimately, most of us would choose a rich and meaningful life over an empty, happy one, if such a thing is even possible. “Misery serves a purpose,” says psychologist David Myers. He’s right. Misery alerts us to dangers. It’s what spurs our imagination. As Iceland proves, misery has its own tasty appeal. A headline on the BBC’s website caught my eye the other day. It read: “Dirt Exposure Boosts Happiness.” Researchers at Bristol University in Britain treated lung-cancer patients with “friendly” bacteria found in soil, otherwise known as dirt. The patients reported feeling happier and had an improved quality of life. The research, while far from conclusive, points to an essential truth: We thrive on messiness. “The good life . . . cannot be mere indulgence. It must contain a measure of grit and truth,” observed geographer Yi-Fu Tuan. Tuan is the great unheralded geographer of our time and a man whose writing has accompanied me throughout my journeys. He called one chapter of his autobiography “Salvation by Geography.” The title is tongue-in-cheek, but only slightly, for geography can be our salvation. We are shaped by our environment and, if you take this Taoist belief one step further, you might say we are our environment. Out there. In here. No difference. Viewed that way, life seems a lot less lonely. The word “utopia” has two meanings. It means both “good place” and “nowhere.” That’s the way it should be. The happiest places, I think, are the ones that reside just this side of paradise. The perfect person would be insufferable to live with; likewise, we wouldn’t want to live in the perfect place, either. “A lifetime of happiness! No man could bear it: It would be hell on Earth,” wrote George Bernard Shaw, in his play Man and Superman. Ruut Veenhoven, keeper of the database, got it right when he said: “Happiness requires livable conditions, but not paradise.” We humans are imminently adaptable. We survived an Ice Age. We can survive anything. We find happiness in a variety of places and, as the residents of frumpy Slough demonstrated, places can change. Any atlas of bliss must be etched in pencil. My passport is tucked into my desk drawer again. I am relearning the pleasures of home. The simple joys of waking up in the same bed each morning. The pleasant realization that familiarity breeds contentment and not only contempt. Every now and then, though, my travels resurface and in unexpected ways. My iPod crashed the other day. I lost my entire music collection, nearly two thousand songs. In the past, I would have gone through the roof with rage. This time, though, my anger dissipated like a summer thunderstorm and, to my surprise, I found the Thai words mai pen lai on my lips. Never mind. Let it go. I am more aware of the corrosive nature of envy and try my best to squelch it before it grows. I don’t take my failures quite so hard anymore. I see beauty in a dark winter sky. I can recognize a genuine smile from twenty yards. I have a newfound appreciation for fresh fruits and vegetables. Of all the places I visited, of all the people I met, one keeps coming back to me again and again: Karma Ura,

Suffering seems to destroy so many things that give life meaning that it may feel impossible to even go on. In the last weeks of his life, my father faced a great range of life-ending, painful illnesses all at once. He had congestive heart failure and three kinds of cancer, even as he was dealing with a gall bladder attack, emphysema, and acute sciatica. At one time he said to a friend, "What's the point?" He was too sick to do the things that made his life meaningful- so why go on? At my father's funeral, his friend related to us how he gently reminded my father of some basic themes in the Bible. If God had kept him in this world, then there were still some things for him to do for those around him. Jesus was patient under even greater suffering for us, so we can be patient under lesser suffering for him. and heaven will make amends for everything.

After hearing much from his patients about alleged faith-healing, a Minnesota physician named William Nolen spent a year and a half trying to track down the most striking cases. Was there clear medical evidence that the disease was really present before the ‘cure’? If so, had the disease actually disappeared after the cure, or did we just have the healer’s or the patient’s say-so? He uncovered many cases of fraud, including the first exposure in America of ‘psychic surgery’. But he found not one instance of cure of any serious organic (non-psychogenic) disease. There were no cases where gallstones or rheumatoid arthritis, say, were cured, much less cancer or cardiovascular disease. When a child’s spleen is ruptured, Nolen noted, perform a simple surgical operation and the child is completely better. But take that child to a faith-healer and she’s dead in a day.

Once I had been diagnosed with a terminal illness, I began to view the world through two perspectives; I was starting to see death as both doctor and patient. As a doctor, I knew not to declare “Cancer is a battle I’m going to win!” or ask “Why me?” (Answer: Why not me?) I knew a lot about medical care, complications, and treatment algorithms. I quickly learned from my oncologist and my own study that stage IV lung cancer today was a disease whose story might be changing, like AIDS in the late 1980s: still a rapidly fatal illness but with emerging therapies that were, for the first time, providing years of life. While being trained as a physician and scientist had helped me process the data and accept the limits of what that data could reveal about my prognosis, it didn’t help me as a patient. It didn’t tell Lucy and me whether we should go ahead and have a child, or what it meant to nurture a new life while mine faded. Nor did it tell me whether to fight for my career, to reclaim the ambitions I had single-mindedly pursued for so long, but without the surety of the time to complete them. Like my own patients, I had to face my mortality and try to understand what made my life worth living—and I needed Emma’s help to do so. Torn between being a doctor and being a patient, delving into medical science and turning back to literature for answers, I struggled, while facing my own death, to rebuild my old life—or perhaps find a new one. —

When Franklin D. Roosevelt signed the Social Security Act in 1935, old age was defined as sixty-five years, yet estimated life expectancy in the United States at the time was sixty-one years for males and sixty-four years for females.62 A senior citizen today, however, can expect to live eighteen to twenty years longer. The downside is that he or she also should expect to die more slowly. The two most common causes of death in 1935 America were respiratory diseases (pneumonia and influenza) and infectious diarrhea, both of which kill rapidly. In contrast, the two most common causes of death in 2007 America were heart disease and cancer (each accounted for about 25 percent of total deaths). Some heart attack victims die within minutes or hours, but most elderly people with heart disease survive for years while coping with complications such as high blood pressure, congestive heart failure, general weakness, and peripheral vascular disease. Many cancer patients also remain alive for several years following their diagnosis because of chemo-therapy, radiation, surgery, and other treatments. In addition, many of the other leading causes of death today are chronic illnesses such as asthma, Alzheimer’s, type 2 diabetes, and kidney disease, and there has been an upsurge in the occurrence of nonfatal but chronic illnesses such as osteoarthritis, gout, dementia, and hearing loss.63 Altogether, the growing prevalence of chronic illness among middle-aged and elderly individuals is contributing to a health-care crisis because the children born during the post–World War II baby boom are now entering old age, and an unprecedented percentage of them are suffering from lingering, disabling, and costly diseases. The term epidemiologists coined for this phenomenon is the “extension of morbidity.

Generally speaking,” he remarked, “the family doctor is the most comforting figure in our lives, and now he’s being pulled up by the roots. The family doctor is a figure without whom the family cannot exist in a developed society. He knows the needs of each member of the family, just as the mother knows their tastes. There’s no shame in taking to him some trivial complaint you’d never take to the outpatients’ clinic, which entails getting an appointment card and waiting your turn, and where there’s a quota of nine patients an hour. And yet all neglected illnesses arise out of these trifling complaints. How many adult human beings are there, now, at this minute, rushing about in mute panic wishing they could find a doctor, the kind of person to whom they can pour out the fears they have deeply concealed or even found shameful? Looking for the right doctor is the sort of thing you can’t always ask your friends for advice about. You can’t advertise for one in a newspaper either. In fact, it’s a matter as essentially intimate as a search for a husband or a wife. But nowadays it’s easier to find a good wife than a doctor ready to look after you personally for as long as you want, and who understands you fully and truly.

Nonviolent coercion always brings tension to the surface. This tension, however, must not be seen as destructive. There is a kind of tension that is both healthy and necessary for growth. Society needs nonviolent gadflies to bring its tensions into the open and force its citizens to confront the ugliness of their prejudices and the tragedy of their racism. It is important for the liberal to see that the oppressed person who agitates for his rights is not the creator of tension....How strange it would be to condemn a physician who, through persistent work and the ingenuity of his medical skills, discovered cancer in a patient. Would anyone be so ignorant as to say he caused the cancer? Through the skills and discipline of direct action we reveal that there is a dangerous cancer of hatred and racism in our society. We did not cause the cancer; we merely exposed it. Only through this kind of exposure will the cancer be cured.

I learn so much that I previously did not know about the world of the immobile that it is hard to believe it all takes place over a few hours. At random: I learn about the casual indifference of the London cabbie to the wheelchair user and that the clearance on accessible entrances is measured in millimetres less than a knuckle. I learn how intractable it is to push a grown man around for hours and how spontaneity is the privilege of the able-bodied. In solid counterpart to all this grief, I learn about the lengths nurses are prepared to go to assist a purely recreational and ambitious project by one of their patients.

But what sort of experiment? An English statistician named Bradford Hill (a former victim of TB himself) proposed an extraordinary solution. Hill began by recognizing that doctors, of all people, could not be entrusted to perform such an experiment without inherent biases. Every biological experiment requires a “control” arm—untreated subjects against whom the efficacy of a treatment can be judged. But left to their own devices, doctors were inevitably likely (even if unconsciously so) to select certain types of patients upfront, then judge the effects of a drug on this highly skewed population using subjective criteria, piling bias on top of bias. Hill

In the United States medical treatment is the third highest cause of death (iatrogenic death) after cancer and heart disease. So, despite our undoubted progress in understanding the chemistry and biological structure of the body, and great advances in the techniques of medical intervention, we are not exceeding the achievements of medieval doctors as much as we might expect. In their terms we are doing worse, because the objective of their care was not necessarily to save the body (which would, of course, be wonderful) but to help save the soul by allowing patients to know the hour of their death, and prepare for it. This was itself a genuine medical skill and, again, one that depended on seeing the patient as a human being.

...turned into a horrific mistake. Lucy Willis had observed that folic acid, if administered to nutrient-deprived patients, could restore the normal genesis of blood. Farber wondered whether administering folic acid to children with leukemia might also restore normalcy to their blood. Following that tenuous trail, he obtained some synthetic folic acid, recruited a cohort of leukemic children, and started injecting folic acid into them. In the months that passed, Farber found that folic acid, far from stopping the progression of leukemia, actually accelerated it. In one patient, the white cell count nearly doubled. In another, the leukemia cells exploded into the bloodstream and sent fingerlings of malignant cells to infiltrate the skin. Farber stopped the experiment in a hurry.

Bear in mind that Mother Teresa’s global income is more than enough to outfit several first-class clinics in Bengal. The decision not to do so, and indeed to run instead a haphazard and cranky institution which would expose itself to litigation and protest were it run by any branch of the medical profession, is a deliberate one. The point is not the honest relief of suffering but the promulgation of a cult based on death and suffering and subjection. Mother Teresa (who herself, it should be noted, has checked into some of the finest and costliest clinics and hospitals in the West during her bouts with heart trouble and old age) once gave this game away in a filmed interview. She described a person who was in the last agonies of cancer and suffering unbearable pain. With a smile, Mother Teresa told the camera what she told this terminal patient: “You are suffering like Christ on the cross. So Jesus must be kissing you.” Unconscious of the account to which this irony might be charged, she then told of the sufferer’s reply: “Then please tell him to stop kissing me.” There are many people in the direst need and pain who have had cause to wish, in their own extremity, that Mother Teresa was less free with her own metaphysical caresses and a little more attentive to actual suffering.

Dr. Richard Selzer is a surgeon and a favorite author of mine. He writes the most beautiful and compassionate descriptions of his patients and the human dramas they confront. In his book Letters to a Young Doctor, he said that most young people seem to be protected for a time by an imaginary membrane that shields them from horror. They walk in it every day but are hardly aware of its presence. As the immune system protects the human body from the unseen threat of harmful bacteria, so this mythical membrane guards them from life-threatening situations. Not every young person has this protection, of course, because children do die of cancer, congenital heart problems, and other disorders. But most of them are shielded—and don’t realize it. Then, as years roll by, one day it happens. Without warning, the membrane tears, and horror seeps into a person’s life or into the life of a loved one. It is at this moment that an unexpected theological crisis presents itself.

Yet the hunger to treat patients still drove Farber. And sitting in his basement laboratory in the summer of 1947, Farber had a single inspired idea: he chose, among all cancers, to focus his attention on one of its oddest and most hopeless variants—childhood leukemia. To understand cancer as a whole, he reasoned, you needed to start at the bottom of its complexity, in its basement. And despite its many idiosyncrasies, leukemia possessed a singularly attractive feature: it could be measured. Science begins with counting. To understand a phenomenon, a scientist must first describe it; to describe it objectively, he must first measure it. If cancer medicine was to be transformed into a rigorous science, then cancer would need to be counted somehow—measured in some reliable, reproducible way. In this, leukemia was different from nearly every other type of cancer. In a world before CT scans and MRIs, quantifying the change in size of an internal solid tumor in the lung or the breast was virtually impossible without surgery: you could not measure what you could not see. But leukemia, floating freely in the blood, could be measured as easily as blood cells—by drawing a sample of blood or bone marrow and looking at it under a microscope. If leukemia could be counted, Farber reasoned, then any intervention—a chemical sent circulating through the blood, say—could be evaluated for its potency in living patients. He could watch cells grow or die in the blood and use that to measure the success or failure of a drug. He could perform an “experiment” on cancer.

Lots of concerned friends and family felt that the first medication’s failure was a clear sign that drugs were not the answer; if they were I would have been fixed. Clearly I wasn’t as sick as I said I was if the medication didn’t work for me. And that sort of makes sense, because when you have cancer the doctor gives you the best medicine and if it doesn’t shrink the tumor immediately then that’s a pretty clear sign you were just faking it for attention. I mean, cancer is a serious, often fatal disease we’ve spent billions of dollars studying and treating so obviously a patient would never have to try multiple drugs, surgeries, radiation, etc., to find what will work specifically for them. And once the cancer sufferer is in remission they’re set for life because once they’ve learned how to not have cancer they should be good. And if they let themselves get cancer again they can just do whatever they did last time. Once you find the right cancer medication you’re pretty much immune from that disease forever. And if you get it again it’s probably just a reaction to too much gluten or not praying correctly. Right?

People always feel sorry for you if you’re physically sick. It doesn’t matter if you have cancer or a cold. People always feel sorry for you and ask you if you’re okay. You need money? You got it! You want to meet a celebrity? Of course you can! You want to go to a convention, ComiCon, Disney World, anywhere in the world? You’re going to go there. That doesn’t happen when you’re mentally ill. If you’re mentally ill, people look at you differently. People roll their eyes when you talk about how sad you are. People won’t lift a finger to help you. “Get a job,” they’ll tell you. “Stop being so lazy. Be grateful you don’t have cancer. Get over it. It’s in the past. You have no reason to be sad.” And that isn’t how it works. But, of course, they wouldn’t know that. They’ve never been mentally ill, they don’t know how you can be so permanently damaged by your past that your present is painful and your future looks bleak. They don’t understand that most days getting out of bed is a chore. They don’t get that sometimes getting a job is out of the question because you’re just too damn afraid to even speak to anyone. That isn’t something you can just get over. But no one knows that because mental illnesses aren’t a real problem apparently. Apparently, the fact that over 800,000 million people die from suicide each year isn’t a real problem. Apparently, the fact that 15% of the adolescent population self-harms isn’t a real problem either. And, apparently, it isn’t a cause to worry that one in 200 American women suffer from an eating disorder. And, as I stand on the balcony, staring at the glittering city, thinking about the short time I spent in Paperthin Hearts, meeting all of the damaged children, I wonder how in the world people don’t understand what a mistake they’re making when they assume that having cancer is worse than being depressed or anxious or wanting to starve yourself to the point of death. How is that a mystery to anyone? Cancer patients are told they’re brave. They’re all made out to be martyrs. They’re given everything they need. Almost all of them. Mental health patients? They’re lucky if they get the right treatment they need before their broken, bleeding hearts, desperate only for love, destroy a part of them that can never be repaired.

Harm reduction is often perceived as being inimical to the ultimate purpose of “curing” addiction—that is, of helping addicts transcend their habits and to heal. People regard it as “coddling” addicts, as enabling them to continue their destructive ways. It’s also considered to be the opposite of abstinence, which many regard as the only legitimate goal of addiction treatment. Such a distinction is artificial. The issue in medical practice is always how best to help a patient. If a cure is possible and probable without doing greater harm, then cure is the objective. When it isn’t — and in most chronic medical conditions cure is not the expected outcome — the physician’s role is to help the patient with the symptoms and to reduce the harm done by the disease process. In rheumatoid arthritis, for example, one aims to prevent joint inflammation and bone destruction and, in all events, to reduce pain. In incurable cancers we aim to prolong life, if that can be achieved without a loss of life quality, and also to control symptoms. In other words, harm reduction means making the lives of afflicted human beings more bearable, more worth living. That is also the goal of harm reduction in the context of addiction. Although hardcore drug addiction is much more than a disease, the harm reduction model is essential to its treatment. Given our lack of a systematic, evidencebased approach to addiction, in many cases it’s futile to dream of a cure. So long as society ostracizes the addict and the legal system does everything it can to heighten the drug problem, the welfare and medical systems can aim only to mitigate some of its effects. Sad to say, in our context harm reduction means reducing not only the harm caused by the disease of addiction, but also the harm caused by the social assault on drug addicts.

Steve Harmon, thirty-six, had esophageal cancer growing at the inlet of his stomach. For six months, he had soldiered through chemotherapy as if caught in a mythical punishment cycle devised by the Greeks. He was debilitated by perhaps the severest forms of nausea that I had ever encountered in a patient, but he had to keep eating to avoid losing weight. As the tumor whittled him down week by week, he became fixated, absurdly, on the measurement of his weight down to a fraction of an ounce, as if gripped by the fear that he might vanish altogether by reaching zero. Meanwhile, a growing retinue of family members accompanied him to his clinic visits: three children who came with games and books and watched, unbearably, as their father shook with chills one morning; a brother who hovered suspiciously, then accusingly, as we shuffled and reshuffled medicines to keep Steve from throwing up; a wife who bravely shepherded the entire retinue through the whole affair as if it were a family trip gone horribly wrong. One morning, finding Steve alone on one of the reclining chairs of the infusion room, I asked him whether he would rather have the chemotherapy alone, in a private room. Was it, perhaps, too much for his family—for his children? He looked away with a flicker of irritation. “I know what the statistics are.” His voice was strained, as if tightening against a harness. “Left to myself, I would not even try. I’m doing this because of the kids.

Yet there is dynamism in our house. Day to day, week to week, Cady blossoms: a first grasp, a first smile, a first laugh. Her pediatrician regularly records her growth on charts, tick marks indicating her progress over time. A brightening newness surrounds her. As she sits in my lap smiling, enthralled by my tuneless singing, an incandescence lights the room. Time for me is now double-edged: every day brings me further from the low of my last relapse but closer to the next recurrence—and, eventually, death. Perhaps later than I think, but certainly sooner than I desire. There are, I imagine, two responses to that realization. The most obvious might be an impulse to frantic activity: to “live life to its fullest,” to travel, to dine, to achieve a host of neglected ambitions. Part of the cruelty of cancer, though, is not only that it limits your time; it also limits your energy, vastly reducing the amount you can squeeze into a day. It is a tired hare who now races. And even if I had the energy, I prefer a more tortoiselike approach. I plod, I ponder. Some days, I simply persist. If time dilates when one moves at high speeds, does it contract when one moves barely at all? It must: the days have shortened considerably. With little to distinguish one day from the next, time has begun to feel static. In English, we use the word time in different ways: “The time is two forty-five” versus “I’m going through a tough time.” These days, time feels less like the ticking clock and more like a state of being. Languor settles in. There’s a feeling of openness. As a surgeon, focused on a patient in the OR, I might have found the position of the clock’s hands arbitrary, but I never thought them meaningless. Now the time of day means nothing, the day of the week scarcely more. Medical training is relentlessly future-oriented, all about delayed gratification; you’re always thinking about what you’ll be doing five years down the line. But now I don’t know what I’ll be doing five years down the line. I may be dead. I may not be. I may be healthy. I may be writing. I don't know. And so it's not all that useful to spend time thinking about the future - that is, beyond lunch.

Between 1995 and 1997 the California-based healthcare network Kaiser Permanente gave more than 17,000 patients a questionnaire to assess the level of trauma in their childhoods. Questions included whether the patients' parents had been mentally or physically abusive or neglectful and whether their parents were divorced or had abused substances. This was called the Adverse Childhood Experiences (ACE) study. After taking the questionnaire, patients were given an ACE score on a scale of 0 to 10. The higher the score, the more trauma a person experienced in childhood. The results of the study were astoundingly clear: The more childhood trauma someone had suffered, the worse their health outcomes were in adulthood. And their risk for contracting diseases didn't go up just a few percentage points. People with high ACE scores were about three times as likely to develop liver disease, twice as likely to develop cancer or heart disease, four times as likely to develop emphysema. They were seven and a half times more likely to become alcoholics, four and a half times more likely to suffer from depression, and a whopping twelve times more likely to attempt suicide. Scientists have learned that stress is literally toxic. Stress chemicals surging through our bodies like cortisol and adrenaline are healthy in moderation—you wouldn't be able to get up in the morning without a good dose of cortisol. But in overwhelming quantities, they become toxic and can change the structure of our brains. Stress and depression wear our bodies out. And childhood trauma affects our telomeres. Telomeres are like little caps on the ends of our strands of DNA that keep them from unraveling. As we get older, those telomeres get shorter and shorter. When they've finally disappeared, our DNA itself begins to unravel, increasing our chances of getting cancer and making us especially susceptible to disease. Because of this, telomeres are linked to human lifespan. And studies have shown that people who have suffered from childhood trauma have significantly shortened telomeres. In the end, these studies claimed that having an ACE score of 6 or higher takes twenty years off your life expectancy. The average life expectancy for someone with 6 or more ACEs is sixty years old.