Christopher Hitchens - Mortality

Still and all, this is both an exhilarating and a melancholy time to have a cancer like mine. Exhilarating, because my calm and scholarly oncologist, Dr. Frederick Smith, can design a chemo-cocktail that has already shrunk some of my secondary tumors, and can “tweak” said cocktail to minimize certain nasty side effects. That wouldn’t have been possible when Updike was writing his book or when Nixon was proclaiming his “war.” But melancholy, too, because new peaks of medicine are rising and new treatments beginning to be glimpsed, and they have probably come too late for me.

For example, I was encouraged to learn of a new “immunotherapy protocol,” evolved by Drs. Steven Rosenberg and Nicholas Restifo at the National Cancer Institute. Actually, the word “encouraged” is an understatement. I was hugely excited. It is now possible to remove T cells from the blood, subject them to a process of genetic engineering, and then reinject them to attack the malignancy. “Some of this may sound like space-age medicine,” wrote Dr. Restifo, as if he, too, had been rereading Updike, “but we have treated well over 100 patients with gene-engineered T cells, and have treated over 20 patients with the exact approach that I am suggesting may be applicable to your case.” There was a catch, and it involved a “match.” My tumor had to express a protein called NY-ESO-1, and my immune cells had to have a particular molecule named HLA-A2. Given this pairing, the immune system could be charged up to resist the tumor. The odds looked good, in that half of those with European or Caucasian genes do have that very molecule. And my tumor when analyzed did have the protein! But my immune cells declined to identify as sufficiently “Caucasian”. Other similar trials are under review by the Food and Drug Administration, but I am in a bit of a hurry, and I can’t forget the feeling of flatness that I experienced when I received the news.

Best perhaps to get these false hopes behind one quickly: It was in the same week that I was told that I didn’t have the necessary mutations in my tumor to qualify for any other of the “targeted” cancer therapies currently on offer. A night or so later I was emailed by perhaps fifty friends because 60 Minutes had run a segment about the “tissue engineering,” by way of stem cells, of a man with a cancerous esophagus. He had effectively been medically enabled to “grow” a new one. I excitedly contacted my friend Dr. Collins, father of genome-based treatment, who gently but firmly told me that my cancer has spread too far beyond my esophagus to be treatable by such a means.

Analyzing the blues that I developed during those lousy seven days, I discovered that I felt cheated as well as disappointed. “Until you have done something for humanity,” wrote the great American educator Horace Mann, “you should be ashamed to die.” I would have happily offered myself as an experimental subject for new drugs or new surgeries, partly of course in the hope that they might salvage me, but also on the Mann principle. And I didn’t even qualify for the adventure. So I have to trudge on with the chemo routine, augmented if it proves worthwhile by radiation and perhaps the much-discussed CyberKnife for a surgical intervention: both of these things; near-miraculous when compared with the recent past.

There is an even longer shot that I do propose to attempt, even though its likely efficacy lies at the outer limits of probability. I am going to try to have my entire DNA “sequenced,” along with the genome of my tumor. Francis Collins was typically sober in his evaluation of the usefulness of this. If the two sequencings could be performed, he wrote to me, “it could be clearly determined what mutations were present in the cancer that is causing it to grow. The potential for discovering mutations in the cancer cells that could lead to a new therapeutic idea is uncertain—this is at the very frontier of cancer research right now.” Partly for that reason, as he advised me, the cost of having it done is also very steep at the moment. But to judge by my correspondence, practically everybody in this country has either had cancer or has a friend or relative who has been a victim of it. So perhaps I will be able to contribute a little bit to enlarging the knowledge that will help future generations.

I say “perhaps” partly because Francis has now had to lay aside a lot of his pioneering work, in order to defend his profession from a legal blockade of its most promising avenue of endeavor. Even as he and I were having those partly thrilling and partly lowering conversations, last August a federal judge in Washington, D.C., ordered a halt to all government expenditure on embryonic stem-cell research. Judge Royce Lamberth was responding to a suit from supporters of the so-called Dickey-Wicker Amendment, named for the Republican duo who in 1995 managed to forbid federal spending on any research that employs a human embryo. As a believing Christian, Francis is squeamish about the creation for research purposes of these nonsentient cell clumps (as, if you care, am I), but he was hoping for good work to result from the use of already existing embryos, originally created for in vitro fertilization. These embryos are going nowhere as it is. But now religious maniacs strive to forbid even their use, which would help what the same maniacs regard as the unformed embryo’s fellow humans! The politicized sponsors of this pseudoscientific nonsense should be ashamed to live, let alone die. If you want to take part in the “war” against cancer, and other terrible maladies, too, then join the battle against their lethal stupidity.

EVER SINCE I WAS FELLED IN MID-BOOK TOUR IN THE summer of 2010, I have adored and seized all chances to play catch-up and to keep as many engagements as I can. Debating and lecturing are part of the breath of life to me, and I take deep drafts whenever and wherever possible. I also truly enjoy the face time with you, dear reader, whether or not you bring a receipt for a shiny new copy of my memoirs. But here is what happened a few weeks ago. Picture, if you will, me sitting at my table, approached by a motherly-looking woman (a key constituent of my demographic):

SHE: I was so sorry to hear you had been ill.

ME: Thank you for saying so.

SHE: A cousin of mine had cancer.

ME: Oh, I am sorry to hear that.

SHE: [ As the line of customers lengthens behind her ] Yes, in his liver.

ME: That’s never good.

SHE: But it went away, after the doctors had told him it was incurable.

ME: Well, that’s what we all want to hear.

SHE: [ With those farther back in line now showing signs of impatience ] Yes. But then it came back, much worse than before.

ME: Oh, how dreadful.

SHE: And then he died. It was agonizing.

Agonizing . Seemed to take him forever.

ME: [ Beginning to search for words ]…

SHE: Of course, he was a lifelong homosexual.

ME: [ Not quite finding the words, and not wishing to sound stupid by echoing “of course” ]…

SHE: And his whole immediate family disowned him. He died virtually alone.

ME: Well, I hardly know what to…

SHE: Anyway, I just wanted you to know that I understand exactly what you are going through.

This was a surprisingly exhausting encounter, without which I could easily have done. It made me wonder if perhaps there was room for a short handbook of cancer etiquette. This would apply to sufferers as well as to sympathizers. After all, I have hardly been reticent about my own malady. But nor do I walk around sporting a huge lapel button that reads, ASK ME ABOUT STAGE FOUR METASTASIZED ESOPHAGEAL CANCER, AND ONLY ABOUT THAT. In truth, if you can’t bring me news about that and that alone, and about what happens when lymph nodes and lung may be involved, I am not all that interested or all that knowledgeable. One almost develops a kind of elitism about the uniqueness of one’s own personal disorder. So, if your own first- or secondhand tale is about some other organs, you might want to consider telling it sparingly, or at least more selectively. This suggestion applies whether the story is intensely depressing and lowering to the spirit—see above—or whether it is intended to convey uplift and optimism: “My grandmother was diagnosed with terminal melanoma of the G-spot and they just about gave up on her. But she hung in there and took huge doses of chemotherapy and radiation at the same time, and the last postcard we had was from her at the top of Mount Everest.” Once again, your narrative may fail to grip if you haven’t taken any care to find out how well or badly your audience member is faring (or feeling).