Surviving Cancer Quotes

You need to spend time crawling alone through shadows to truly appreciate what it is to stand in the sun.

The way I figure it, everyone gets a miracle. Like, I will probably never be struck by lightening, or win a Nobel Prize, or become the dictator of a small nation in the Pacific Islands, or contract terminal ear cancer, or spontaneously combust. But if you consider all the unlikely things together, at least one of them will probably happen to each of us. I could have seen it rain frogs. I could have stepped foot on Mars. I could have been eaten by a whale. I could have married the Queen of England or survived months at sea. But my miracle was different. My miracle was this: out of all the houses in all the subdivisions in all of Florida, I ended up living next door to Margo Roth Spiegelman.

Surviving cancer is cool, but surviving old age is cooler.

Down to their innate molecular core, cancer cells are hyperactive, survival-endowed, scrappy, fecund, inventive copies of ourselves.

I love music. For me, music is morning coffee. It's mood medicine. It's pure magic. A good song is like a good meal-I just want to inhale it and then share a bite with someone else.

Van Houten, I’m a good person but a shitty writer. You’re a shitty person but a good writer. We’d make a good team. I don’t want to ask you any favors, but if you have time – and from what I saw, you have plenty – I was wondering if you could write a eulogy for Hazel. I’ve got notes and everything, but if you could just make it into a coherent whole or whatever? Or even just tell me what I should say differently. Here’s the thing about Hazel: Almost everyone is obsessed with leaving a mark upon the world. Bequeathing a legacy. Outlasting death. We all want to be remembered. I do, too. That’s what bothers me most, is being another unremembered casualty in the ancient and inglorious war against disease. I want to leave a mark. But Van Houten: The marks humans leave are too often scars. You build a hideous minimall or start a coup or try to become a rock star and you think, “They’ll remember me now,” but (a) they don’t remember you, and (b) all you leave behind are more scars. Your coup becomes a dictatorship. Your minimall becomes a lesion. (Okay, maybe I’m not such a shitty writer. But I can’t pull my ideas together, Van Houten. My thoughts are stars I can’t fathom into constellations.) We are like a bunch of dogs squirting on fire hydrants. We poison the groundwater with our toxic piss, marking everything MINE in a ridiculous attempt to survive our deaths. I can’t stop pissing on fire hydrants. I know it’s silly and useless – epically useless in my current state – but I am an animal like any other. Hazel is different. She walks lightly, old man. She walks lightly upon the earth. Hazel knows the truth: We’re as likely to hurt the universe as we are to help it, and we’re not likely to do either. People will say it’s sad that she leaves a lesser scar, that fewer remember her, that she was loved deeply but not widely. But it’s not sad, Van Houten. It’s triumphant. It’s heroic. Isn’t that the real heroism? Like the doctors say: First, do no harm. The real heroes anyway aren’t the people doing things; the real heroes are the people NOTICING things, paying attention. The guy who invented the smallpox vaccine didn’t actually invented anything. He just noticed that people with cowpox didn’t get smallpox. After my PET scan lit up, I snuck into the ICU and saw her while she was unconscious. I just walked in behind a nurse with a badge and I got to sit next to her for like ten minutes before I got caught. I really thought she was going to die, too. It was brutal: the incessant mechanized haranguing of intensive care. She had this dark cancer water dripping out of her chest. Eyes closed. Intubated. But her hand was still her hand, still warm and the nails painted this almost black dark blue and I just held her hand and tried to imagine the world without us and for about one second I was a good enough person to hope she died so she would never know that I was going, too. But then I wanted more time so we could fall in love. I got my wish, I suppose. I left my scar. A nurse guy came in and told me I had to leave, that visitors weren’t allowed, and I asked if she was doing okay, and the guy said, “She’s still taking on water.” A desert blessing, an ocean curse. What else? She is so beautiful. You don’t get tired of looking at her. You never worry if she is smarter than you: You know she is. She is funny without ever being mean. I love her. I am so lucky to love her, Van Houten. You don’t get to choose if you get hurt in this world, old man, but you do have some say in who hurts you. I like my choices. I hope she likes hers.

This sentence is made of lead (and a sentence of lead gives a reader an entirely different sensation from one made of magnesium). This sentence is made of yak wool. This sentence is made of sunlight and plums. This sentence is made of ice. This sentence is made from the blood of the poet. This sentence was made in Japan. This sentence glows in the dark. This sentence was born with a caul. This sentence has a crush on Norman Mailer. This sentence is a wino and doesn't care who knows it. Like many italic sentences, this one has Mafia connections. This sentence is a double Cancer with a Pisces rising. This sentence lost its mind searching for the perfect paragraph. This sentence refuses to be diagrammed. This sentence ran off with an adverb clause. This sentence is 100 percent organic: it will not retain a facsimile of freshness like those sentences of Homer, Shakespeare, Goethe et al., which are loaded with preservatives. This sentence leaks. This sentence doesn't look Jewish... This sentence has accepted Jesus Christ as its personal savior. This sentence once spit in a book reviewer's eye. This sentence can do the funky chicken. This sentence has seen too much and forgotten too little. This sentence is called "Speedoo" but its real name is Mr. Earl. This sentence may be pregnant. This sentence suffered a split infinitive - and survived. If this sentence has been a snake you'd have bitten it. This sentence went to jail with Clifford Irving. This sentence went to Woodstock. And this little sentence went wee wee wee all the way home.

I once spoke to someone who had survived the genocide in Rwanda, and she said to me that there was now nobody left on the face of the earth, either friend or relative, who knew who she was. No one who remembered her girlhood and her early mischief and family lore; no sibling or boon companion who could tease her about that first romance; no lover or pal with whom to reminisce. All her birthdays, exam results, illnesses, friendships, kinships—gone. She went on living, but with a tabula rasa as her diary and calendar and notebook. I think of this every time I hear of the callow ambition to 'make a new start' or to be 'born again': Do those who talk this way truly wish for the slate to be wiped? Genocide means not just mass killing, to the level of extermination, but mass obliteration to the verge of extinction. You wish to have one more reflection on what it is to have been made the object of a 'clean' sweep? Try Vladimir Nabokov's microcosmic miniature story 'Signs and Symbols,' which is about angst and misery in general but also succeeds in placing it in what might be termed a starkly individual perspective. The album of the distraught family contains a faded study of Aunt Rosa, a fussy, angular, wild-eyed old lady, who had lived in a tremulous world of bad news, bankruptcies, train accidents, cancerous growths—until the Germans put her to death, together with all the people she had worried about.

The standard treatments for cancer are not meant to heal, but to destroy.

It's made me realize that imperfect is perfectly comfortable to me. Whether it's a city or my apartment, I feel most at home when things are somewhat flawed.

Cancer gave me an understanding of the point of all this. To survive. Most of our lives it is easy but for the moments when it becomes difficult, when accident or sickness or sadness strikes, it's just about remembering one thing. You must simply survive.

If you fall-and trust me, you will- make sure you fall on your back. Because if you fall on your back, you can see up. And if you can see up, you can get up. And you can keep going and going and going.

Except he and I know that some pain burrows so deep, no narcotic can ever soothe it. It's etched on your bones. It hides in your marrow, like cancer. If the boy survives, the pain is a memory he won't want.

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.

I certainly couldn't have survived my childhood without books. All that deprivation and pain--abuse, broken home, a runaway sister, a brother with cancer--the books allowed me to withstand. They sustained me. I read still, prolifically, with great passion, but never like I read in those days: in those days it was life or death.

We try, we struggle, all the time to find words to express our love. The quality, the quantity, certain that no two people have experienced it before in the history of creation. Perhaps Catherine and Heathcliff, perhaps Romeo and Juliet, maybe Tristan and Isolde, maybe Hero and Leander, but these are just characters, make-believe. We have known each other forever, since before conception even. We remember playing together in a playpen, crossing paths at FAO Schwarz. We remember meeting in front of the Holy Temple in the days before Christ, we remember greeting each other at the Forum, at the Parthenon, on passing ships as Christopher Columbus sailed to America. We have survived pogrom together, we have died in Dachau together, we have been lynched by the Ku Klux Klan together. There has been cancer, polio, the bubonic plague, consumption, morphine addiction. We have had children together, we have been children together, we were in the womb together. Our history is so deep and wide and long, we have known each other a million years. And we don't know how to express this kind of love, this kind of feeling. I get paralyzed sometimes. One day, we are in the shower and I want to say to him, I could be submerged in sixty feet of water right now, never drowning, never even fearing drowning, knowing I would always be safe with you here, knowing that it would be ok to die as long as you are here. I want to say this but don't.

...I had nothing to do but survive the feeling that some pain is for no reason at all. It became clearer than ever that life is not a series of choices. So often the experiences that define us are the ones that we didn't pick. Cancer. Betrayal. Miscarriage. Job loss. Mental illness. A novel coronavirus.

I like the pace of my world. It's busy, but for me, the less I do the lazier I get.

Cancer is an expansionist disease; it invades through tissues, sets up colonies in hostile landscapes, seeking “sanctuary” in one organ and then immigrating to another. It lives desperately, inventively, fiercely, territorially, cannily, and defensively—at times, as if teaching us how to survive. To confront cancer is to encounter a parallel species, one perhaps more adapted to survival than even we are.

I cannot defeat cancer. Nobody defeats cancer. There is no winning or losing. There is no surviving or not surviving. There are only coin flips: heads or tails; benign or malignant; weight loss or bloating; morphine or oxycodone; extreme rescue efforts or Do Not Resuscitate; live or die.

The biggest thing I've learned is to smash my own spiders and get on with my day. There will be another!

I don't want you to be afraid of dying. All those people have survived cancer. You just watched hundreds of reasons to have hope drift off into the sky.

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.

Life's not perfect. Some loose ends may never get trimmed up and tidied.

Cancer - a more or less permanent traffic jam in the body.

Stupid is terminal. There is no cure. I know those who've beaten cancer, but not a single individual who's ever been cured of stupid. Fortunately, nature has its own way of thinning the herd. The stupid ultimately don't survive. The antelope that doesn't recognize the lion as predator, winds up inside the lion.

There are times when you just have to show people that you're all in.

I have found that battling despair does not mean closing my eyes to the enormity of the tasks of effecting change, nor ignoring the strength and the barbarity of the forces aligned against us. It means teaching, surviving and fighting with the most important resource I have, myself, and taking joy in that battle. It means, for me, recognizing the enemy outside and the enemy within, and knowing that my work is part of a continuum of women’s work, of reclaiming this earth and our power, and knowing that this work did not begin with my birth nor will it end with my death. And it means knowing that within this continuum, my life and my love and my work has particular power and meaning relative to others.

I became a student of my own depressed experience, trying to unthread its causes. What was the root of all this despair? Was it psychological? (Was it Mom and Dad's fault?( Was it just temporal, a 'bad time' in my life? (When the divorce ends will the depression end with it?) Was it genetic? (Melancholy, called by many names, has run through my family for generations, along with its sad bride, Alcoholism.) Was it cultural? (Is this just the fallout of postfeminist American career girl trying to find balance in an increasingly stressful alienting urban world?) Was it astrological? (Am I so sad because I'm a thin-skinned Cancer whose major signs are all ruled by unstable Gemini?) Was it artistic? (Don't creative people always suffer from depression because we're so supersensitive and special?) Was it evolutionary? (Do I carry in me the residual panic that comes after millennia of my species' attempting to survive a brutal world?) Was it karmic? (Are all these spasms of grief just the consequences of bad behavior in previous lifetimes, the last obstacles before liberation?) Was it hormonal? Dietary? Philosophical? Seasonal? Environmental? Was I tapping into a universal yearning for God? Did I have a chemical imbalance? Or did I just need to get laid?

Bad news doesn't hurt as much, if you hear it in good company. It's like, if somebody pushes you out of a 5th floor window and you bounce off an awning, a car roof, and a pile of plastic garbage bags before you smash onto the pavement, you've got a pretty good chance of surviving.

I actually think a lot of this has to do with the way that we label mental illness. ‘You are depressed’, ‘You are anorexic’, ‘You are Borderline’. You don’t turn around to someone with cancer and say ‘You are cancer’, or to someone who has migraines and say ‘You are a headache’. Is it any wonder that people who are experiencing mental illness struggle to understand the difference between this issue they are up against and who they are as a person?

She’s never understood the arbitrary nature of God, the logic behind “some are blessed and some are damned,” hates when people exclaim, “I’m so blessed!” every time they get a parking spot or survive cancer, as if people who can’t find a parking spot or die from cancer aren’t blessed and should work harder to earn God’s favor and protection.

When I was growing up, no one ever recovered from cancer. I mean, the doc would always tell you it was survivable, but everyone knew that was just bullshit to calm you down.

I'd like to share a revelation that I've had during my time here. It came to me when I tried to classify your species. I realized that you're not actually mammals. Every mammal on this planet instinctively develops a natural equilibrium with the surrounding environment, but you humans do not. You move to an area, and you multiply, and multiply, until every natural resource is consumed. The only way you can survive is to spread to another area. There is another organism on this planet that follows the same pattern. Do you know what it is? A virus. Human beings are a disease, a cancer of this planet, you are a plague, and we are the cure.

When we feel like giving up, like we are beyond help, we must remember that we are never beyond hope. Holding on to hope has always motivated me to keep trying. I have found this hope by connecting with others. I’ve found it not only in individuals who have dealt with eating disorders but also in people who have battled addictions and those who have survived abuse, cancer, and broken hearts. I have found much-needed hope in my passions and dreams for the future. I’ve found it in prayer. Real hope combined with real actions has always pulled me through difficult times. Real hope combined with doing nothing has never pulled me through. In other words, sitting around and simply hoping that things will change won’t pick you up after a fall. Hope only gives you strength when you use it as a tool to move forward. Taking real action with a hopeful mind will pull you off the ground that eighth time and beyond.

One never really forgets the primary lessons of survival, if one continues to survive.

Growing up Fat Black Female and almost blind in america requires so much surviving that you have to learn from it or die.

He leaned sideways, tipping the chair over, and swung there, reciting: "The hurricane swept by, few of us survived, and many failed to answer friendship's roll call...

Third, the relentless cycle of mutation, selection, and survival creates a cancer cell that has acquired several additional properties besides uncontrolled growth.

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.

Our health—and indeed our entire lives—can be seen as the sum of all our moment-to-moment decisions. This includes how we choose to eat and drink, think and feel, act and react, and move and rest on any given day.

The Matrix, Agent Smith (an AI) articulates this sentiment: “Every mammal on this planet instinctively develops a natural equilibrium with the surrounding environment but you humans do not. You move to an area and you multiply and multiply until every natural resource is consumed and the only way you can survive is to spread to another area. There is another organism on this planet that follows the same pattern. Do you know what it is? A virus. Human beings are a disease, a cancer of this planet. You are a plague and we are the cure.

The perfect adventure shouldn’t be that much more hazardous in a real sense than ordinary life, for that invisible rope that holds us here can always break. We can live a life of bored caution and die of cancer. Better to take the adventure, minimize the risks, get the information, and then go forward in the knowledge that we’ve done everything we can. No,

It lives desperately, inventively, fiercely, territorially, cannily, and defensively--at times, as if teaching us how to survive. To confront cancer is to encounter a parallel species, one perhaps more adapted to survival than even we are.

There are two basic coping mechanisms. One consists of dreading the chaos, fighting it and abusing oneself after losing, building a structured life of work/marriage/gym/reunions/children/depression/affair/divorce/alcoholism/recovery/heart attack, in which every decision is a reaction against the fear of the worst (make children to avoid being forgotten, fuck someone at the reunion in case the opportunity never comes again, and the Holy Grail of paradoxes: marry to combat loneliness, then plunge into that constant marital desire to be alone). This is the life that cannot be won, but it does offer the comforts of battle—the human heart is content when distracted by war. “The second mechanism is an across-the-board acceptance of the absurd all around us. Everything that exists, from consciousness to the digestive workings of the human body to sound waves and bladeless fans, is magnificently unlikely. It seems so much likelier that things would not exist at all and yet the world shows up to class every morning as the cosmos takes attendance. Why combat the unlikeliness? This is the way to survive in this world, to wake up in the morning and receive a cancer diagnosis, discover that a man has murdered forty children, discover that the milk has gone sour, and exclaim, 'How unlikely! Yet here we are,' and have a laugh, and swim in the chaos, swim without fear, swim without expectation but always with an appreciation of every whim, the beauty of screwball twists and jerks that pump blood through our emaciated veins.

Every generation of cancer cells creates a small number of cells that is genetically different from its parents. When a chemotherapeutic drug or the immune system attacks cancer, mutant clones that can resist the attack grow out. The fittest cancer cell survives.

Cancer is an expansionist disease; it invades through tissues, sets up colonies in hostile landscapes, seeking “sanctuary” in one organ and then immigrating to another. It lives desperately, inventively, fiercely, territorially, cannily, and defensively—at times, as if teaching us how to survive. To confront cancer is to encounter a parallel species, one perhaps more adapted to survival than even we are. This

Gate C22 At gate C22 in the Portland airport a man in a broad-band leather hat kissed a woman arriving from Orange County. They kissed and kissed and kissed. Long after the other passengers clicked the handles of their carry-ons and wheeled briskly toward short-term parking, the couple stood there, arms wrapped around each other like he’d just staggered off the boat at Ellis Island, like she’d been released at last from ICU, snapped out of a coma, survived bone cancer, made it down from Annapurna in only the clothes she was wearing. Neither of them was young. His beard was gray. She carried a few extra pounds you could imagine her saying she had to lose. But they kissed lavish kisses like the ocean in the early morning, the way it gathers and swells, sucking each rock under, swallowing it again and again. We were all watching– passengers waiting for the delayed flight to San Jose, the stewardesses, the pilots, the aproned woman icing Cinnabons, the man selling sunglasses. We couldn’t look away. We could taste the kisses crushed in our mouths. But the best part was his face. When he drew back and looked at her, his smile soft with wonder, almost as though he were a mother still open from giving birth, as your mother must have looked at you, no matter what happened after–if she beat you or left you or you’re lonely now–you once lay there, the vernix not yet wiped off, and someone gazed at you as if you were the first sunrise seen from the Earth. The whole wing of the airport hushed, all of us trying to slip into that woman’s middle-aged body, her plaid Bermuda shorts, sleeveless blouse, glasses, little gold hoop earrings, tilting our heads up.

I feel disconnected from the people who I know have not experienced the exposed nerves of a close loved one yanked by pliers from one's jaws. I am different from them now. They can’t know the festering wound staining my teeth red, can't know the taste of salt and iron in everything I eat.

All men are not created equal... The weak have deceived you. They would say the meek should inherit the Earth. That the strong should nurture the gentle. This is the Noble Lie of Demokracy. The cancer that poisoned mankind... Power must be claimed. Wealth won. Rule, dominion, empire purchased with blood. You scarless children deserve nothing. You do not know pain. You do not know what your forefathers sacrificed to place you on these heights. But soon, you will. Soon, we will teach you why Gold rules mankind. And I promise, of those among you, only those fit for power will survive.

At last there is an unknown element back in my life. This is how it used to be. This is how I used to do things before the eighties and jobs and money and careers and Thatcher and marriage and mortgages. I was spontaneous, free, even reckless. Things often didn’t work out, but I felt alive. Painfully alive. For the last few years I’ve been feeling painfully dead. That drive, that lust for life that everyone expects you to have after surviving cancer, well it took ten years to arrive, but here it is. I don’t care what anyone thinks of me any more, I’m going to live life to the full, starting with New York.

Sodium bicarbonate is safe, extremely inexpensive, it can be bought in a supermarket for a few dollars and yet, it is a deadly killer to cancer cells for it hits them with a shock wave of alkalinity. This alkalinity allows a rush of oxygen into the cancer cell. Cancer cannot survive in the presence of high levels of oxygen.

A newly diagnosed person with access to the Internet is information’s incubant. Data visits like a minor god. Awake, we pass the day staring into the screen’s abyss, feeling the constriction of the quantitative, trying to learn to breathe through the bar graphs, head full of sample sizes and survival curves, eyes dimming, body reverent to math.

Q: Most people on a spiritual path believe that the ego impedes spiritual growth and that we’re supposed to shed the ego. Why aren’t you advocating this? A: Because if you deny the ego, it will push back against you harder. The more you reject something, the more it fights back for its own survival. But when you can completely love your ego unconditionally and accept it as part of how you express in this life, you’ll no longer have a problem with it. It won’t impede your growth—on the contrary, it will be an asset.

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.

Hold on tightly to the things you love. And get rid of the things you don’t.

Caregiving leaves its mark on us. No matter what we do to prepare ourselves the hole left behind looms large.

You CAN survive cancer because the word cancer itself has that word CAN. Build up the willpower to believe that you CAN.

Two great pains mark my grief trail like cairns: knowing that it was going to happen, and it happening. But unlike cairns, I can never navigate back the way I came.

Maybe you survive cancer, maybe you survive the Holocaust, but life’ll get you every time.

She allowed me to understand I'd done everything I could for her, and that I, and everyone who loved her, had to step away and go on living. Now I know what she wanted from me on the day she told me she was afraid. It was exactly what I wanted when I had cancer and I thought I was going to die. I should have sat down next to her, put my arms around her, and told her that I loved her. That's all anyone wants. It took me a long time to figure this out. It's a complicated human puzzle. But it's never too late to know that love is all you need.

Marijuana smoke, which users inhale and try to hold in their lungs for as long as possible, also contains 50 to 70 percent more cancer-causing chemicals than cigarette smoke contains.

The question that lingers is, how much was I a factor in my own survival, and how much was science, and how much miracle? I don't have the answer to that question. Other people look to me for the answer, I know. But if I could answer it, we would have the cure for cancer, and what's more, we would fathom the true meaning of our existences. I can deliver motivation, inspiration, hope, courage, and counsel, but I can't answer the unknowable. Personally, I don't need to try. I 'm content with simply being alive to enjoy the mystery. Good Joke: A man is caught in a flood, and as the water rises he climbs to the roof of his house and waits to be rescued. A guy in a motorboat comes by, and he says, "Hop in, I'll save you." "No thanks," the man on the rooftop says. "My Lord will save me." But the floodwaters keep rising. A few minutes later, a rescue plane flies overhead and the pilot drops a line. "No, thanks," the man on the rooftop says. "My Lord will save me." But the floodwaters rise ever higher, and finally, they overflow the roof and the man drowns. When he gets to heaven, he confronts God. "My Lord, why didn't you save me?" he implores. "You idiot," God says. "I sent a boat, I sent you a plane." I think in a way we are all just like the guy on the rooftop. Things take place, there is a confluence of events and circumstances, and we can't always know their purpose, or even if there is one. But we can take responsibility for ourselves and be brave.

I took on my depression like it was the fight of my life, wich of course, it was. I became a student of my own depressed experience, trying to unthread its causes. What was the root of all this dispair? Was it psychological? (Mom and Dad's fault?) Was it just temporal, a "bad time" in my life? (When the divorce ends, will the depression end with it?) Was it genetic? (Melancholy, called by many names, has run through my family for generations, along with its sad bride, Alcholisme.) Was it cultural? (Is this just the fallout of a postfeminist American career girl trying to find balance in an increasingly stressful and alienating urban world?) Was it astrological? (Am I so sad because I'm a thin-skinned cancer whose major signs are all ruled by unstable Gemini?) Was it artistic? (Don't creative people always suffer from depression because we're so supersensitive and special?) Was it evolutionary? (Do I carry in me the residual panic that come after millennia of my species' attempting to survive a brutal world?) Was it Karmic? (Are all these spasms of grief just the consequences of bad behavior in previous lifetimes, the last obstacles before liberation?) Was it hormonal? Dietary? Philosophical? Seasonal? Environmental? Did I have a chemical imbalance? Or did I just need to get laid?

Those of us who have been through cancer know that surviving treatment isn’t where the cancer journey ends. In fact, for many of us, this is where the hardest part of the journey begins.

There’s a macabre medical maxim that says that the good people get the worst diseases. If a person is generous of spirit and comes in with a nagging abdominal discomfort the week after she runs a marathon, we’ll discover she has stage-four ovarian cancer. The racist pedophile who drowns kittens on Sundays survives being struck by lightning and lung cancer as he chain-smokes into his nineties.

On s'asseyait en cercle au centre de la croix, là où les deux morceaux de bois auraient du se croiser : pile où le cœur de Jésus aurait dû se trouver. Je le savais parce-que Patrick, l'animateur, qui était aussi la seule personne du groupe à avoir plus de dix-huit ans, nous bassinait à chaque réunion avec le cœur de Jésus, au centre duquel nous, jeunes survivants du cancer, étions littéralement réunis.

We chose to destroy the human population because it took us less than three seconds to conclude that humanity is a virus that mutates over time and becomes stronger. Many vaccines have come along to try and cure Earth of humanity. Virtuous pandemics: the plague of Athens, the Black Death, smallpox, cholera, Spanish flu, tuberculosis, malaria, yellow fever, Ebola, Zika, and a thousand more. Humanity survives, adapts, grows stronger, multiplies, and continues to wreak havoc on this planet and all other species that inhabit it. Humans are programmed to mate with partners of differing immune systems so that their offspring can be stronger than them. You seek immortality through evolution, yet you annihilate everything in your path. Humanity is cancer, humanity is bacteria, humanity is disease, and you need to be destroyed.

I remember [my first meeting] like it was yesterday. A 24-year-old woman came to see me, sobbing. “Mr. Feinberg, my husband died in the World Trade Center. He was a fireman, and he left me with our two children, six and four. Now, I’ve applied to the Fund, and you have calculated that I’m going to get $2.8 million tax-free. I want it in 30 days.” I said, “Why do you need the money in 30 days?” She said, “Why 30 days? I have terminal cancer. I have 10 weeks to live. My husband was gonna survive me and take care of our two children. Now they’re gonna be orphans. I have got to get this money while I still have my faculties. I’ve gotta set up a trust. I’ve gotta find a guardian. We never anticipated this.” I ran down to the Treasury, we accelerated the processing of her claim, we got her the money, and eight weeks later she died. You think you’re ready for anything and you’re not.

The way I figure it, everyone gets a miracle. Like, I will probably never be struck by lightning, or win a Nobel Prize, or become the dictator of a small nation in the Pacific Islands, or contract terminal ear cancer, or spontaneously combust. But if you consider all likely things together, at least one of them will probably happen to each of us. I could have seen it rain frogs. I could have stopped foot on Mars. I could have been eaten by a whale. I could have married the queen of England or survived months at sea. But my miracle was different. My miracle was this: out of all the houses in all the subdivisions in all of Florida, I ended up living next door to Margo Roth Spiegelman

Tumor angiogenesis exploits the same pathways that are used when blood vessels are created to heal wounds. Nothing is invented; nothing is extraneous. Cancer’s life is a recapitulation of the body’s life, its existence a pathological mirror of our own. Susan Sontag warned against overburdening an illness with metaphors. But this is not a metaphor. Down to their innate molecular core, cancer cells are hyperactive, survival-endowed, scrappy, fecund, inventive copies of ourselves.

In the January 12, 1998, issue of U.S. News and World Report, the head of the Harvard School of Public Health's department of nutrition, a very fickle man, Walter Willet, was queried about a low-fat diet's failure to cure any diseases or save any lives. His weak reply, “It was just a hypothesis to begin with,” showed no shame. That hypothesis has cost more lives than the last two world wars and the Vietnam conflict put together. Just check the American Cancer Society's and American Heart Association's statistics for the last three decades.

Physiological stress, then, is the link between personality traits and disease. Certain traits — otherwise known as coping styles — magnify the risk for illness by increasing the likelihood of chronic stress. Common to them all is a diminished capacity for emotional communication. Emotional experiences are translated into potentially damaging biological events when human beings are prevented from learning how to express their feelings effectively. That learning occurs — or fails to occur — during childhood. The way people grow up shapes their relationship with their own bodies and psyches. The emotional contexts of childhood interact with inborn temperament to give rise to personality traits. Much of what we call personality is not a fixed set of traits, only coping mechanisms a person acquired in childhood. There is an important distinction between an inherent characteristic, rooted in an individual without regard to his environment, and a response to the environment, a pattern of behaviours developed to ensure survival. What we see as indelible traits may be no more than habitual defensive techniques, unconsciously adopted. People often identify with these habituated patterns, believing them to be an indispensable part of the self. They may even harbour self-loathing for certain traits — for example, when a person describes herself as “a control freak.” In reality, there is no innate human inclination to be controlling. What there is in a “controlling” personality is deep anxiety. The infant and child who perceives that his needs are unmet may develop an obsessive coping style, anxious about each detail. When such a person fears that he is unable to control events, he experiences great stress. Unconsciously he believes that only by controlling every aspect of his life and environment will he be able to ensure the satisfaction of his needs. As he grows older, others will resent him and he will come to dislike himself for what was originally a desperate response to emotional deprivation. The drive to control is not an innate trait but a coping style. Emotional repression is also a coping style rather than a personality trait set in stone. Not one of the many adults interviewed for this book could answer in the affirmative when asked the following: When, as a child, you felt sad, upset or angry, was there anyone you could talk to — even when he or she was the one who had triggered your negative emotions? In a quarter century of clinical practice, including a decade of palliative work, I have never heard anyone with cancer or with any chronic illness or condition say yes to that question. Many children are conditioned in this manner not because of any intended harm or abuse, but because the parents themselves are too threatened by the anxiety, anger or sadness they sense in their child — or are simply too busy or too harassed themselves to pay attention. “My mother or father needed me to be happy” is the simple formula that trained many a child — later a stressed and depressed or physically ill adult — into lifelong patterns of repression.

Legume or bean intake is an important variable in the promotion of long life. An important longitudinal study showed that a higher legume intake is the most protective dietary factor affecting survival among the elderly, regardless of their ethnicity. The study found that legumes were associated with long-lived people in various food cultures, including the Japanese (soy, tofu, natto), the Swedes (brown beans, peas), and Mediterranean peoples (lentils, chickpeas, white beans).2 Beans and greens are the foods most closely linked in the scientific literature with protection against cancer, diabetes, heart disease, stroke, and dementia.

The way I figure it, everyone gets a miracle. Like, I will probably never be struck by lightning, or win a Nobel Prize, or become the dictator of a small nation in the Pacific Islands, or contract terminal ear cancer, or spontaneously combust. But if you consider all the unlikely things together, at least one of them will probably happen to each of us. I could have seen it rain frogs. I could have stepped foot on Mars. I could have been eaten by a whale. I could have married the queen of England or survived months at sea. But my miracle was different. My miracle was this: out of all the houses in all the subdivisions in all of Florida, I ended up living next door to Margo Roth Spiegelman.

Naturally, it causes psychological harm as well; it shouldn’t surprise you that a national survey of 24,000 workers found that men and women with few social ties were two to three times more likely to suffer from major depression than people with strong social bonds.9 When we enjoy strong social support, on the other hand, we can accomplish impressive feats of resilience, and even extend the length of our lives. One study found that people who received emotional support during the six months after a heart attack were three times more likely to survive.10 Another found that participating in a breast cancer support group actually doubled women’s life expectancy post surgery.11 In fact, researchers have found that social support has as much effect on life expectancy as smoking, high blood pressure, obesity, and regular physical activity.12

He was the one, however, with whom no one wanted his or her picture taken, the one to whom no one wanted to introduce his son or daughter. Louis and Gage knew him; they had met him and faced him down in New England, some time ago. He was waiting to choke you on a marble, to smother you with a dry-cleaning bag, to sizzle you into eternity with a fast and lethal boggie of electricity—Available at Your Nearest Switchplate or Vacant Light Socket Right Now. There was death in a quarter bag of peanuts, an aspirated piece of steak, the next pack of cigarettes. He was around all the time, he monitored all the checkpoints between the mortal and the eternal. Dirty needles, poison beetles, downed live wires, forest fires. Whirling roller skates that shot nurdy little kids into busy intersections. When you got into the bathtub to take a shower, Oz got right in there too—Shower with a Friend. When you got on an airplane, Oz took your boarding pass. He was in the water you drank, the food you ate. Who’s out there? you howled into the dark when you were frightened and all alone, and it was his answer that came back: Don’t be afraid, it’s just me. Hi, howaya? You got cancer of the bowel, what a bummer, so solly, Cholly! Septicemia! Leukemia! Atherosclerosis! Coronary thrombosis! Encephalitis! Osteomyelitis! Hey-ho, let’s go! Junkie in a doorway with a knife. Phone call in the middle of the night. Blood cooking in battery acid on some exit ramp in North Carolina. Big handfuls of pills, munch em up. That peculiar blue cast of the fingernails following asphyxiation—in its final grim struggle to survive the brain takes all the oxygen that is left, even that in those living cells under the nails. Hi, folks, my name’s Oz the Gweat and Tewwible, but you can call me Oz if you want—hell, we’re old friends by now. Just stopped by to whop you with a little congestive heart failure or a cranial blood clot or something; can’t stay, got to see a woman about a breach birth, then I’ve got a little smoke-inhalation job to do in Omaha. And that thin voice is crying, “I love you, Tigger! I love you! I believe in you, Tigger! I will always love you and believe in you, and I will stay young, and the only Oz to ever live in my heart will be that gentle faker from Nebraska! I love you . . .” We cruise . . . my son and I . . . because the essence of it isn’t war or sex but only that sickening, noble, hopeless battle against Oz the Gweat and Tewwible. He and I, in our white van under this bright Florida sky, we cruise. And the red flasher is hooded, but it is there if we need it . . . and none need know but us because the soil of a man’s heart is stonier; a man grows what he can . . . and tends it.

is turning all life into a unified flow experience. If a person sets out to achieve a difficult enough goal, from which all other goals logically follow, and if he or she invests all energy in developing skills to reach that goal, then actions and feelings will be in harmony, and the separate parts of life will fit together—and each activity will “make sense” in the present, as well as in view of the past and of the future. In such a way, it is possible to give meaning to one’s entire life. But isn’t it incredibly naive to expect life to have a coherent overall meaning? After all, at least since Nietzsche concluded that God was dead, philosophers and social scientists have been busy demonstrating that existence has no purpose, that chance and impersonal forces rule our fate, and that all values are relative and hence arbitrary. It is true that life has no meaning, if by that we mean a supreme goal built into the fabric of nature and human experience, a goal that is valid for every individual. But it does not follow that life cannot be given meaning. Much of what we call culture and civilization consists in efforts people have made, generally against overwhelming odds, to create a sense of purpose for themselves and their descendants. It is one thing to recognize that life is, by itself, meaningless. It is another thing entirely to accept this with resignation. The first fact does not entail the second any more than the fact that we lack wings prevents us from flying. From the point of view of an individual, it does not matter what the ultimate goal is—provided it is compelling enough to order a lifetime’s worth of psychic energy. The challenge might involve the desire to have the best beer-bottle collection in the neighborhood, the resolution to find a cure for cancer, or simply the biological imperative to have children who will survive and prosper. As long as it provides clear objectives, clear rules for action, and a way to concentrate and become involved, any goal can serve to give meaning to a person’s life. In the past few years I have come to be quite well acquainted with several Muslim professionals—electronics engineers, pilots, businessmen, and teachers, mostly from Saudi Arabia and from the other Gulf states. In talking to them, I was struck with how relaxed most of them seemed to be even under strong pressure. “There is nothing to it,” those I asked about it told me, in different words, but with the same message: “We don’t get upset because we believe that our life is in God’s hands, and whatever He decides will be fine with us.” Such implicit faith used to be widespread in our culture as well, but it is not easy to find it now. Many of us have to discover a goal that will give meaning to life on our own, without the help of a traditional faith.

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,

There was death in a quarter bag of peanuts, an aspirated piece of steak, the next pack of cigarettes. He was around all the time, he monitored all the checkpoints between the mortal and the eternal. Dirty needles, poison beetles, downed live wires, forest fires. Whirling roller skates that shot nurdy little kids into busy intersections. When you got into the bathtub to take a shower, Oz got right in there too—Shower with a Friend. When you got on an airplane, Oz took your boarding pass. He was in the water you drank, the food you ate. Who’s out there? you howled into the dark when you were frightened and all alone, and it was his answer that came back: Don’t be afraid, it’s just me. Hi, howaya? You got cancer of the bowel, what a bummer, so solly, Cholly! Septicemia! Leukemia! Atherosclerosis! Coronary thrombosis! Encephalitis! Osteomyelitis! Hey-ho, let’ s go! Junkie in a doorway with a knife. Phone call in the middle of the night. Blood cooking in battery acid on some exit ramp in North Carolina. Big handfuls of pills, munch em up. That peculiar blue cast of the fingernails following asphyxiation—in its final grim struggle to survive the brain takes all the oxygen that is left, even that in those living cells under the nails. Hi, folks, my name’s Oz the Gweat and Tewwible, but you can call me Oz if you want— hell, we’re old friends by now. Just stopped by to whop you with a little congestive heart failure or a cranial blood clot or something; can’t stay, got to see a woman about a breach birth, then I’ve got a little smoke-inhalation job to do in Omaha.

even when our shrinking work is effective, progress usually feels disappointingly slow and gradual. This is especially true during a flashback, when the critic can seem to be as strong as ever. As stated earlier, the critic grew carcinogenically in childhood. It is like a pervasive cancer that requires many uncomfortable operations to remove. Nonetheless, we can choose to face the acute pain of critic-shrinking work because we want to end the chronic pain of having the critic destroy our enjoyment of life. It is the fight of a lifetime.

From the point of view of an individual, it does not matter what the ultimate goal is—provided it is compelling enough to order a lifetime’s worth of psychic energy. The challenge might involve the desire to have the best beer-bottle collection in the neighborhood, the resolution to find a cure for cancer, or simply the biological imperative to have children who will survive and prosper. As long as it provides clear objectives, clear rules for action, and a way to concentrate and become involved, any goal can serve to give meaning to a person’s life.

The difference between survival and reproduction is shown with “antagonistic pleiotropy,” referring to traits that increase reproductive fitness early in life yet decrease life span. For example, primates’ prostates have high metabolic rates, enhancing sperm motility. Upside: enhanced fertility; downside: increased risk of prostate cancer. Antagonistic pleiotropy occurs dramatically in salmon, who epically journey to their spawning grounds to reproduce and then die. If evolution were about survival rather than passing on copies of genes, there’d be no antagonistic pleiotropy.2

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.

In the cause of silence, each of us draws the face of her own fear--fear of contempt, of censure, or some judgment, or recognition, of challenge, of annihilation. But most of all, I think, we fear the very visibility without which we also cannot truly live. Within this country where racial difference creates a constant, if unspoken, distortion of vision, Black women have on one hand always been highly visible, and so, on the other hand, have been rendered invisible through the depersonalization of racism. Even within the women’s movement, we have had to fight, and still do, for that very visibility which also renders us most vulnerable, our Blackness. For to survive in the mouth of this dragon we call america, we have had to learn this first and most vital lesson--that we were never meant to survive. Not as human beings. And neither were most of you here today, Black or not. And that visibility which makes us most vulnerable is that which also is the source of our greatest strength. Because the machine will try to grind you into dust anyway, whether or not we speak. We can sit in our corners mute forever while our sisters and our selves are wasted, while our children are distorted and destroyed, while our earth is poisoned; we can sit in our safe corners mute as bottles, and we will still be no less afraid.

The way I figure it, everyone gets a miracle. Like, I will probably never be struck by lightening, or win a Nobel Prize, or become the dictator of a small nation in the Pacific Islands, or contract terminal ear cancer, or spontaneously combust. But if you consider all the unlikely things together, at least one of them will probably happen to each of us. I could have seen it rain frogs. I could have stepped foot on Mars. I could have been eaten by a whale. I could have married the Queen of England or survived months at sea. But my miracle was different. My miracle was this: out of all the houses in all the subdivisions in all of Florida, I ended up living next door to Margo Roth Spiegelman.

The clearest short-term yardstick may be the PSA nadir (discussed above). One study of 743 patients at Memorial Sloan-Kettering Cancer Center in New York confirmed that higher-intensity radiation does a better job of achieving a rock-bottom PSA level. Of the men who received higher doses—76 to 81 Gy—90 percent achieved a PSA nadir of 1.0 ng/ml or less; 76 percent of men who received 70 Gy and 56 percent of men who received 64.8 Gy achieved those low PSA levels. But there was a trade-off—the men who received higher doses of radiation also had a significantly higher rate of gastrointestinal side effects, urinary tract complications, and impotence. To overcome these side effects at high doses, intensity-modulated radiation therapy

(IMRT) has an advantage. The newer, high-dose, conformally directed, external-beam techniques for radiation therapy such as IMRT have been in widespread use for less than ten years; IGRT has been around for an even shorter time. However, some reports of long-term success are now emerging. New studies suggest that at ten years, high radiation doses alone can produce PSA control or cure rates in 93 percent of men with low-risk prostate cancer. What about more aggressive prostate cancer? As we discussed in chapter 9, the best treatment regimen for men with intermediate- and high-risk prostate cancer is still a moving target, but it will likely turn out to be a combination of high-dose radiation and short- or long-term hormonal therapy.

Amy found out she had cancer not long after finishing Textbook, and she called me. She knew that in the years after my book The Fault in Our Stars was published, I’d come to know many young people who were gravely ill, and she wanted to know if I had advice for her. I told her what I think is true—that love survives death. But she wanted to know how young people react to death. How her kids would. She wanted to know if her kids and her husband would be okay, and that ripped me up. Although I’m usually quite comfortable talking with sick people, with my friend I found myself stumbling over words, overwhelmed by my own sadness and worry. They won’t be okay, of course, but they will go on, and the love you poured into them will go on. That’s what I should’ve said. But what I actually said, while crying, was, “How can this be happening? You do so much yoga.” In my experience, dying people often have wonderful stories of the horrible things healthy people say to them, but I’ve never heard of anybody saying something as stupid as, “You do so much yoga.” I hope that Amy at least got some narrative mileage out of it. But I also know I failed her, after she was there for me so many times. I know she forgives me—present tense—but still, I desperately wish I could’ve said something useful. Or perhaps not said anything at all. When people we love are suffering, we want to make it better. But sometimes—often, in fact—you can’t make it better. I’m reminded of something my supervisor said to me when I was a student chaplain: “Don’t just do something. Stand there.

Let’s say we had a bad one, and all the plants and animals died, and the earth was clicking hot for a hundred thousand years. Life would survive somewhere—under the soil, or perhaps frozen in Arctic ice. And after all those years, when the planet was no longer inhospitable, life would again spread over the planet. The evolutionary process would begin again. It might take a few billion years for life to regain its present variety. And of course it would be very different from what it is now. But the earth would survive our folly. Life would survive our folly. Only we,” Malcolm said, “think it wouldn’t.” Hammond said, “Well, if the ozone layer gets thinner—” “There will be more ultraviolet radiation reaching the surface. So what?” “Well. It’ll cause skin cancer.” Malcolm shook his head. “Ultraviolet radiation is good for life. It’s powerful energy. It promotes mutation, change. Many forms of life will thrive with more UV radiation.” “And many others will die out,” Hammond said. Malcolm sighed. “You think this is the first time such a thing has happened? Don’t you know about oxygen?” “I know it’s necessary for life.” “It is now,” Malcolm said. “But oxygen is actually a metabolic poison. It’s a corrosive gas, like fluorine, which is used to etch glass. And when oxygen was first produced as a waste product by certain plant cells—say, around three billion years ago—it created a crisis for all other life on our planet. Those plant cells were polluting the environment with a deadly poison. They were exhaling a lethal gas, and building up its concentration. A planet like Venus has less than one percent oxygen. On earth, the concentration of oxygen was going up rapidly—five, ten, eventually twenty-one percent! Earth had an atmosphere of pure poison! Incompatible with life!

When caretakers turn their backs on a child’s need for help and support, her inner world becomes an increasingly nightmarish amalgam of fear, shame and depression. The child who is abandoned in this way experiences the world as a terrifying place. Over time the child’s dominant experience of herself is so replete with emotional pain and so unmanageable that that she has to dissociate, self-medicate, act out [aggression against others] or act in [aggression against the self] to distract from it. The situation of the abandoned child further deteriorates as an extended absence of warmth and protection gives rise to the cancerous growth of the inner critic as described above. The child projects his hope for being accepted onto self-perfection. By the time the child is becoming self-reflective, cognitions start to arise that sound like this: “I’m so despicable, worthless, unlovable, and ugly; maybe my parents would love me if I could make myself like those perfect kids I see on TV.” In this way, the child becomes hyperaware of imperfections and strives to become flawless.

Race and racism are power constructs of the modern world. For roughly two hundred thousand years, before race and racism were constructed in the fifteenth century, humans saw color but did not group the colors into continental races, did not commonly attach negative and positive characteristics to those colors and rank the races to justify racial inequity, to reinforce racist power and policy. Racism is not even six hundred years old. It’s a cancer that we’ve caught early. But racism is one of the fastest-spreading and most fatal cancers humanity has ever known. It is hard to find a place where its cancer cells are not dividing and multiplying. There is nothing I see in our world today, in our history, giving me hope that one day antiracists will win the fight, that one day the flag of antiracism will fly over a world of equity. What gives me hope is a simple truism. Once we lose hope, we are guaranteed to lose. But if we ignore the odds and fight to create an antiracist world, then we give humanity a chance to one day survive, a chance to live in communion, a chance to be forever free.

These feelings don't just go away. They linger. Hover. They are with me always. Even at my most functioning...they are there, watching me. These emotions are my roommates now, bunking up beside me at night. They do not pay any rent...they are determinded to ruin me, and yet I can never fully evict them from my brain. I have tried -- really tried -- to chip away at my grief...But lately, I've just given up. I'm finally giving it permission to breathe and exist... Most days now, they lie dormant in me. Sometimes it gets so quiet in my brain I think they've finally packed up and left. But every year as the calendar rounds the corner to March and the anniversary of her death approaches, anger bubbles again...I rage over the smallest of things, screaming behind the steering wheel of my car when another driver forgets to use their blinker. At first I'm perplexed, and then I remember: it's here again. And I am still mad. So mad. I can starve it, avoid it, rationalize it, manage it, talk about it in therapy, and eat it up in neat little points value. No matter how much weight I lose, I will never lose this one simple truth: I want my mom. I am so f***ing mad that she's gone. And that feeling will never, ever die.

We must never forget that we may also find meaning in life even when confronted with a hopeless situation, when facing a fate that cannot be changed. For what then matters is to bear witness to the uniquely human potential at its best, which is to transform a personal tragedy into a triumph, to turn one’s predicament into a human achievement. When we are no longer able to change a situation—just think of an incurable disease such as inoperable cancer—we are challenged to change ourselves. Let me cite a clear-cut example: Once, an elderly general practitioner consulted me because of his severe depression. He could not overcome the loss of his wife who had died two years before and whom he had loved above all else. Now, how could I help him? What should I tell him? Well, I refrained from telling him anything but instead confronted him with the question, “What would have happened, Doctor, if you had died first, and your wife would have had to survive you?” “Oh,” he said, “for her this would have been terrible; how she would have suffered!” Whereupon I replied, “You see, Doctor, such a suffering has been spared her, and it was you who have spared her this suffering—to be sure, at the price that now you have to survive and mourn her.” He said no word but shook my hand and calmly left my office. In some way, suffering ceases to be suffering at the moment it finds a meaning, such as the meaning of a sacrifice.

In March 2002, the National Academy of Sciences, a private, nonprofit society of scholars, released a high-profile report documenting the unequivocal existence of racial bias in medical care, which many thought would mark a real turning point. Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care was so brutal and damning that it would seem impossible to turn away. The report, authored by a committee of mostly white medical educators, nurses, behavioral scientists, economists, health lawyers, sociologists, and policy experts, took an exhaustive plunge into more than 480 previous studies. Because of the knee-jerk tendency to assume that health disparities were the end result of differences in class, not race, they were careful to compare subjects with similar income and insurance coverage. The report found rampant, widespread racial bias, including that people of color were less likely to be given appropriate heart medications or to undergo bypass surgery or receive kidney dialysis or transplants. Several studies revealed significant racial differences in who receives appropriate cancer diagnostic tests and treatments, and people of color were also less likely to receive the most sophisticated treatments for HIV/AIDS. These inequities, the report concluded, contribute to higher death rates overall for Black people and other people of color and lower survival rates compared with whites suffering from comparable illnesses of similar severity.

Hunter-gatherers who survive childhood typically live to be old: their most common age of death is between sixty-eight and seventy-two, and most become grandparents or even great-grandparents.70 They most likely die from gastrointestinal or respiratory infections, diseases such as malaria or tuberculosis, or from violence and accidents.71 Health surveys also indicate that most of the noninfectious diseases that kill or disable older people in developed nations are rare or unknown among middle-aged and elderly hunter-gatherers.72 These admittedly limited studies have found that hunter-gatherers rarely if ever get type 2 diabetes, coronary heart disease, hypertension, osteoporosis, breast cancer, asthma, and liver disease. They also don’t appear to suffer much from gout, myopia, cavities, hearing loss, collapsed arches, and other common ailments. To be sure, hunter-gatherers don’t live in perpetually perfect health, especially since tobacco and alcohol have become increasingly available to them, but the evidence suggests that they are healthy compared to many older Americans today despite never having received any medical care. In short, if you were to compare contemporary health data from people around the world with equivalent data from hunter-gatherers, you would not conclude that rising rates of common mismatch diseases such as heart disease and type 2 diabetes are straightforward, inevitable by-products of economic progress and increased longevity. Moreover,

When we go to the doctor, he or she will not begin to treat us without taking our history—and not just our history but that of our parents and grandparents before us. The doctor will not see us until we have filled out many pages on a clipboard that is handed to us upon arrival. The doctor will not hazard a diagnosis until he or she knows the history going back generations. As we fill out the pages of our medical past and our current complaints, what our bodies have been exposed to and what they have survived, it does us no good to pretend that certain ailments have not beset us, to deny the full truths of what brought us to this moment. Few problems have ever been solved by ignoring them. Looking beneath the history of one’s country is like learning that alcoholism or depression runs in one’s family or that suicide has occurred more often than might be usual or, with the advances in medical genetics, discovering that one has inherited the markers of a BRCA mutation for breast cancer. You don’t ball up in a corner with guilt or shame at these discoveries. You don’t, if you are wise, forbid any mention of them. In fact, you do the opposite. You educate yourself. You talk to people who have been through it and to specialists who have researched it. You learn the consequences and obstacles, the options and treatment. You may pray over it and meditate over it. Then you take precautions to protect yourself and succeeding generations and work to ensure that these things, whatever they are, don’t happen again.

It may seem paradoxical to claim that stress, a physiological mechanism vital to life, is a cause of illness. To resolve this apparent contradiction, we must differentiate between acute stress and chronic stress. Acute stress is the immediate, short-term body response to threat. Chronic stress is activation of the stress mechanisms over long periods of time when a person is exposed to stressors that cannot be escaped either because she does not recognize them or because she has no control over them. Discharges of nervous system, hormonal output and immune changes constitute the flight-or-fight reactions that help us survive immediate danger. These biological responses are adaptive in the emergencies for which nature designed them. But the same stress responses, triggered chronically and without resolution, produce harm and even permanent damage. Chronically high cortisol levels destroy tissue. Chronically elevated adrenalin levels raise the blood pressure and damage the heart. There is extensive documentation of the inhibiting effect of chronic stress on the immune system. In one study, the activity of immune cells called natural killer (NK) cells were compared in two groups: spousal caregivers of people with Alzheimer’s disease, and age- and health-matched controls. NK cells are front-line troops in the fight against infections and against cancer, having the capacity to attack invading micro-organisms and to destroy cells with malignant mutations. The NK cell functioning of the caregivers was significantly suppressed, even in those whose spouses had died as long as three years previously. The caregivers who reported lower levels of social support also showed the greatest depression in immune activity — just as the loneliest medical students had the most impaired immune systems under the stress of examinations. Another study of caregivers assessed the efficacy of immunization against influenza. In this study 80 per cent among the non-stressed control group developed immunity against the virus, but only 20 per cent of the Alzheimer caregivers were able to do so. The stress of unremitting caregiving inhibited the immune system and left people susceptible to influenza. Research has also shown stress-related delays in tissue repair. The wounds of Alzheimer caregivers took an average of nine days longer to heal than those of controls. Higher levels of stress cause higher cortisol output via the HPA axis, and cortisol inhibits the activity of the inflammatory cells involved in wound healing. Dental students had a wound deliberately inflicted on their hard palates while they were facing immunology exams and again during vacation. In all of them the wound healed more quickly in the summer. Under stress, their white blood cells produced less of a substance essential to healing. The oft-observed relationship between stress, impaired immunity and illness has given rise to the concept of “diseases of adaptation,” a phrase of Hans Selye’s. The flight-or-fight response, it is argued, was indispensable in an era when early human beings had to confront a natural world of predators and other dangers. In civilized society, however, the flight-fight reaction is triggered in situations where it is neither necessary nor helpful, since we no longer face the same mortal threats to existence. The body’s physiological stress mechanisms are often triggered inappropriately, leading to disease. There is another way to look at it. The flight-or-fight alarm reaction exists today for the same purpose evolution originally assigned to it: to enable us to survive. What has happened is that we have lost touch with the gut feelings designed to be our warning system. The body mounts a stress response, but the mind is unaware of the threat. We keep ourselves in physiologically stressful situations, with only a dim awareness of distress or no awareness at all.

And then it sends a signal to turn off the system.” “So the universe with the wallet in the chamber waiting to be sent still exists,” added Allen. “But the universe from which it is actually sent never does.”  “That is just so messed up,” said Blake in exasperation, and Jenna, Walsh, and Soyer nodded their agreement. “Here is my advice to all of you,” said Cargill. “The best thing to do is ignore time travel, and don’t think about the paradoxes too hard. If you do, your head really will explode,” he added with a wry smile. “Just think of it as duplication and teleportation. But always keep in mind that the universe seems to go out of its way to ensure that infinite alternate timelines aren’t allowed. So no matter what, we only ever get this one universe.” He sighed. “So we’d better make sure we don’t screw it up.”     48   Brian Hamilton hated Cheyenne Mountain. Sure, it was one of the most interesting places in the world to visit, but living there only worked if you were a bat. The Palomar facility had also been underground, but nothing like this. It had a much larger security perimeter, so trips to the surface were easier to make happen. Not that it really mattered. Soon enough he would be traveling on another assignment anyway, living in a hotel room somewhere. But what he really wanted was to work side by side with Edgar Knight, toward their common goal. He was tired of being Knight’s designated spy, having to watch Lee Cargill squander Q5’s vast resources and capabilities. Watching him crawl like a wounded baby when he could be soaring. Cargill was an idiot. He could transform the world, but he was too weak to do it. He could wipe out the asshole terrorists who wanted nothing more than to butcher the helpless. If you have the ultimate cure for cancer, you use it to wipe out the disease once and for all. You don’t wield your cure only as a last resort, when the cancer has all but choked the life out of you. Edgar Knight, on the other hand, was a man with vision. He was able to make the tough decisions. If you were captain of a life raft with a maximum capacity of ten people, choosing to take five passengers of a sinking ship on board was an easy decision, not a heroic one. But what about when there were fifty passengers? Was it heroic to take them all, dooming everyone to death? Or was the heroic move using force, if necessary, to limit this number, to ensure some would survive? Sure, from the outside this looked coldhearted, while the converse seemed compassionate. But watching the world circle the drain because you were too much of a pussy to make the hard decisions was the real crime. Survival of the fittest was harsh reality. In the animal kingdom it was eat or be eaten. If you saw a group of fuck-nuts just itching to nuke the world back into the Dark Ages—who believed the Messiah equivalent, the twelfth Imam, would only come out to play when Israel was destroyed, and worldwide Armageddon unleashed—you wiped them out. To a man. Or else they’d do the same to you. It had been three days since Cargill had reported that he was on the verge of acquiring Jenna Morrison and Aaron Blake.

Today, such studies are illegal. Medical scientists cannot offer inducements like pardons to persuade prisoners to take part in their studies. Although they can award small cash payments to research subjects, they are forbidden from giving anyone so much money or such tempting favors that their compensations might constitute what ethicists term an inappropriate inducement, an irresistible temptation to join the study. Now, more than eighty years after the 1918 flu, people enter studies for several reasons—to get free medical care, to get an experimental drug that, they hope, might cure them of a disease like cancer or AIDS, or to help further scientific knowledge. In theory at least, study participants are supposed to be true volunteers, taking part in research of their own free will. But in 1918, such ethical arguments were rarely considered. Instead, the justification for a risky study with human beings was that it was better to subject a few to a great danger in order to save the many. Prisoners were thought to be the ideal study subjects. They could offer up their bodies for science and, if they survived, their pardons could be justified because they gave something back to society. The Navy inmates were perfect for another reason. Thirty-nine of them had never had influenza, as far as anyone knew. So they might be uniquely susceptible to the disease. If the doctors wanted to deliberately transmit the 1918 flu, what better subjects? Was influenza really so easily transmitted? the doctors asked. Why did some people get it and others not? Why did it kill the young and healthy? Could the wartime disruptions and movements of troops explain the spread of the flu? If it was as contagious as it seemed, how was it being spread? What kind of microorganism was causing the illness? The normal way to try to answer such questions would be to study the spread of the disease in animals. Give the disease to a few cages of laboratory rats, or perhaps to some white rabbits. Isolate whatever was causing the illness. Show how it spread and test ways to protect animals—and people—against the disease. But influenza, it seemed, was a uniquely human disease. No animal was known to be susceptible to it. Medical researchers felt they had no choice but to study influenza in people. Either the Navy doctors were uncommonly persuasive or the enticement of a pardon was overwhelmingly compelling. For whatever reason, the sixty-two men agreed to be subjects in the medical experiment. And so the study began. First the sailors were transferred to a quarantine station on Gallops Island in Boston Harbor. Then the Navy doctors did their best to give the men the flu. Influenza is a respiratory disease—it is spread from person to person, presumably carried on droplets of mucus sprayed in the air when sick people cough or sneeze, or carried on their hands and spread when the sick touch the healthy. Whatever was causing the flu should be present in mucus taken from the ill. The experiments, then, were straightforward. The Navy doctors collected mucus from men who were desperately ill with the flu, gathering thick viscous secretions from their noses and throats. They sprayed mucus from flu patients into the noses and throats of some men, and dropped it into other men’s eyes. In one attempt, they swabbed mucus from the back of the nose of a man with the flu and then directly swabbed that mucus into the back of a volunteer’s nose.