Cancer is What Makes Us Human

By David Biale

“Golden lads and girls all must
As chimney sweepers, come to dust” – (Cymbeline)

              All living things must die.  That iron law of biology is hard to say and even harder to understand.  Why shouldn’t we be at least as eternal as the rocks and the sky, or, failing that, as long-lived as sequoia sempervirens?  And why have we been cursed with the consciousness of our own death, even though grasping non-existence is like trying to hold water between our fingers?  It is said that all of the creations of human beings come from a denial of death, by pushing into the deepest recesses of the mind the most paralyzing thought of them all.

            My own confrontation with mortality has, however, taught me some very different lessons.  At age 71, I felt young in body and spirit when the diagnosis descended on me: metastasized prostate cancer.  A blow to the gut, but, then, what was most surprising was that the sinking feeling of impotence passed within a day or two to reveal instead a clarity that I have only experienced when confronted with the death of others.  Every waking moment — and even those asleep — had now to be devoted to being alive.

            I was fortunate in the cancer that I “chose:” incurable, but slow growing and responsive to the least debilitating treatment.  That treatment consisted of wiping all the testosterone from my body to starve the cancer cells of the fuel that makes them grow and divide.  And then an additional medication to interrupt the cancer’s production of its own testosterone, a self-fueling quirk that makes this cancer so different from all others.

            For many patients, the total eradication of all testosterone comes with a very high price: crippling fatigue, brain fog, depression, muscle wasting and, of course, the death of libido.  The only scientifically-proven antidote to these symptoms is vigorous exercise, including weight lifting.  I was built for this treatment: over the years, although totally unathletic as a child, I had made exercise a bit of a religion, unaware that I would need to call on that devotion in this hour of darkness.  So, I was luckier than most to experience few side effects of what the medical profession delicately calls “chemical castration.”  This made it possible to feel totally well even while carrying within me a deadly time-bomb.

            Even the loss of libido, which happened within a few days of starting treatment, was not as negative as it sounds.  It’s paradoxical: you don’t miss what you don’t experience.  That part of the brain, a primitive part, I think, that powered the mind for so long and that made the female body the object of attraction, had shut down for good.  Since it wasn’t there, I didn’t miss it, because I couldn’t conjure it up.  Having fulfilled my evolutionary destiny of fathering two children, I could now clear my mind for more fateful matters.

            It is perhaps not coincidental that my father died of prostate cancer and the progression of his disease is an always-present memory.  A biologist, he was teaching his last seminar, on the origin of life, as the cancer rampaged in his body.  When a rabbi, a close friend of the family, visited and asked him if he wanted to talk about what he was experiencing, he replied; “I prefer to think about the origins of life and not its end.”  He never complained and seemed intent on living as fully as he could without conceding anything to his enemy until it was no longer possible to do so.

            I say “enemy,” but is that really the right term for cancer?  This disease is not like a foreign invader, but instead a product of our own cells.  Perhaps “civil war” is a better metaphor.  This is, however, a civil war of a very peculiar type.  The genetic theory of cancer teaches that most cancers do not arise from an environmental toxin, although, of course, there are important exceptions such as smoking-induced lung cancer.  My prostate cancer, for instance, may owe something to my father’s genetic legacy that he bequeathed me, or maybe not.  Either way, the cancer arose from mutations within the prostate organ that seems to have a propensity to grow more than it needs to, even when that growth is benign.  Rapidly dividing cells are particularly susceptible to mutations that may eventually produce a neoplasm, cells that no longer resemble prostate cells and are ready to attack any place in the body.

            Mutation: without it, no life.  We are human, the “quintessence of stardust,” because eons ago, a single-celled organism mutated so that it could become something different.  And, finally, those mutations produced us: that creature who is capable of infinite compassion and infinite cruelty to our own species.  But the price of mutation is cancer.  Every member of the animal kingdom, including, it seems, the dinosaurs, can produce cancer out its own cells.  Perhaps cancer is even the way cells program their ultimate demise, so as to make way for our offspring.  Immortality would require totally different laws of nature.  I find these insights oddly comforting, since they make living with cancer and, ultimately, dying of it, something that makes us human.  

“We are such stuff that dreams are made on
And our little life is rounded with a sleep.”  (The Tempest)

            Between those two infinitely long sleeps, we live in full awareness of our limited time.  That awareness conjures up metaphysical thoughts.  I am far from religious, but I now have this heightened feeling that there is something inexplicable, call it “divine,” about our existence.  This world, with all its beauty and, yes, even all its ugliness, exists because I am here to perceive it, interact with it, perhaps even leave a mark on it.  All this will be gone when I am.  I am not, though, a complete idealist.  I do believe that there is a universe out there of space and time, matter and energy.  But it is an utterly unconscious universe into which I will disappear once I die.

            I might call this philosophy “humanism with a spiritual face.”  The source of divinity is us, our work, our loves, and our very being.  Once we are gone, it will be gone.  And yet, not fully gone because it will live on in those who still live.  That is why nuclear war is so terrifying.  Not only will we die, but so will the human race and, so too, the divinity that we can conjure up by our very existence.

            The very threat of death has made me acutely aware of work and love, the twin pillars, as Freud said, of a life well-lived.  Instead of terror, it has had a surprising effect: the more than year and a half since diagnosis has been quite literally the happiest period of my life.  I published my last book some three years before my diagnosis and instead of feeling that I had now so little time to write more, I felt fulfilled by the realization that I had said everything I wanted to say (obviously not entirely true; hence this short essay).  The diagnosis solidified my decision to retire, not because I might become too ill to continue, but on the contrary, because I had finished my teaching as thoroughly as I had finished my writing.  What at times decades ago seemed a search for vocation, a doubting of my intellectual abilities, now feels like a necessary struggle to arrive at a quiet sense that I have completed the work I was meant to do.

            For many, retirement is a dreaded prospect, the last station on the way to the graveyard.  Not for me.  Retirement is, in fact, a kind of memento mori because it means the end of something that had been central to my life for forty-five years. To accept the finality of that ending seems to me a happy lesson before one comes to the most final of endings.

            And what of love?  The end of testosterone meant the end of sex, but not the end of love.  If sex is the most intimate expression of love, it is not the only expression and, indeed, it now seems to me that love without sex — not that I desired it — has its own profound intensity.  One of the first effects of my diagnosis was to launch the writing of a joint memoir with my wife, based on 258 letters we exchanged during the two years when we fell in love.  To recover the intensity of that period, when we were a half century younger than we are now, seemed to draw the arc of our lives, to give us a narrative that integrates everything we set out to do before we knew that we would grow old together.  We started our love by turning life into art (that is, letters) and then we lived it together without reflection in writing.  But now we can look back and see that, like true romantics, we have lived our lives as art.  If life must end, it will now end with a sense of fulfillment beyond anything I could have imagined then:

            And, so, like my biologist father, I too must surrender to biology and to its iron law.  But like him, I am more than just a body.  When the cells of my body are finally defeated by their malignant offspring, I will leave, I hope, a legacy to all who knew me that somehow contains a spark of the divine.

“If I must die I will encounter darkness as a bride
And hug it in mine arms.” (Measure for Measure)

About the Author:

David Biale is Emanuel Ringelblum Distinguished Professor of Jewish History at the University of California, Davis. His most recent books are Hasidism: A New History (with seven co-authors), Gershom Scholem: Master of the Kabbalah and Not in the Heavens: The Tradition of Jewish Secular Thought. Earlier books are Gershom Scholem: Kabbalah and Counter-History, Power and Powerlessness in Jewish History, Eros and the Jews and Blood and Belief: The Circulation of a Symbol Between Jews and Christians. David serves as Chair of the Humanities Subcommittee for The Blood Project. Click here to learn more.