Mortality (4 page)
Many readers are familiar with the spirit and the letter of the definition of “prayer,” as given by Ambrose Bierce in his
Devil’s Dictionary
. It runs like this, and is extremely easy to comprehend:
Prayer: A petition that the laws of nature be suspended in favor of the petitioner; himself confessedly unworthy.
Everybody can see the joke that is lodged within this entry: The man who prays is the one who thinks that god has arranged matters all wrong, but who also thinks that he can instruct god how to put them right. Half–buried in the contradiction is the distressing idea that nobody is in charge, or nobody with any moral authority. The call to prayer is self–cancelling. Those of us who don’t take part in it will justify our abstention on the grounds that we do not need, or care, to undergo the futile process of continuous reinforcement. Either our convictions are enough in themselves or they are not: At any rate they do require standing in a crowd and uttering constant and uniform incantations. This is ordered by one religion to take place five times a day, and by other monotheists for almost that number, while all of them set aside at least one whole day for the exclusive praise of the Lord, and Judaism seems to consist in its original constitution of a huge list of prohibitions that must be followed before all else.
The tone of the prayers replicates the silliness of the mandate, in that god is enjoined or thanked to do what he was going to do anyway. Thus the Jewish male begins each day by thanking god for not making him into a woman (or a Gentile), while the Jewish woman contents herself with thanking the almighty for creating her “as she is.” Presumably the almighty is pleased to receive this tribute to his power and the approval of those he created. It’s just that, if he is truly almighty, the achievement would seem rather a slight one.
Much the same applies to the idea that prayer, instead of making Christianity look foolish, makes it appear convincing. (We’ll just stay with Christianity today.) Now, it can be asserted with some confidence, first, that its deity is all–wise and all–powerful and, second, that its congregants stand in desperate need of that deity’s infinite wisdom and power. Just to give some elementary quotations, it is stated in the book of Philippians, 4:6, “Be careful for nothing; but in everything by prayer and supplication and thanksgiving, let your requests be known to God.” Deuteronomy 32:4 proclaims that “he is the rock, his work is perfect,” and Isaiah 64:8 tells us, “Now O Lord, thou art our father; we art clay and thou our potter; and we are all the work of thy hand.” Note, then, that Christianity insists on the absolute dependence of its flock, and then only on the offering of undiluted praise and thanks. A person using prayer time to ask for the world to be set to rights, or to beseech god to bestow a favor upon himself, would in effect be guilty of a profound blasphemy or at the very least a pathetic misunderstanding. It is not for the mere human to be presuming that he or she can advise the divine. And this, sad to say, opens religion to the additional charge of corruption. The leaders of the church know perfectly well that prayer is not intended to gratify the devout. So that, every time they accept a donation in return for some petition, they are accepting a gross negation of their faith: a faith that depends on the passive acceptance of the devout and not on their making demands for betterment. Eventually, and after a bitter and schismatic quarrel, practices like the notorious “sale of indulgences” were abandoned. But many a fine basilica or chantry would not be standing today if this awful violation had
not
turned such a spectacularly good profit.
And today it is easy enough to see, at the revival meetings of Protestant fundamentalists, the counting of the checks and bills before the laying on of hands by the preacher has even been completed. Again, the spectacle is a shameless one, with the Calvinists having in some ways replaced Rome as the most exorbitant holy fund–raisers. And—before we run out of contradictions— it seems doubly absurd for a Calvinist to take an interest in divine intercession. The founding constitution of the Presbyterian Church famously proclaimed from Philadelphia that “by the decree of God, for the manifestation of his glory, some men and angels are predestinated unto everlasting life and others foreordained for everlasting death . . . without any foresight of faith or good works, or perseverance in either of them, or any other thing in the creature, as conditions.” Plainly put, this means that it does not matter whether you try to lead a holy life, or even succeed in doing so. Random caprice will still determine whether or not you receive a heavenly reward.In these circumstances, the emptiness of prayer is almost the least of it. Beyond that minor futility, the religion which treats its flock as a credulous plaything offers one of the cruelest spectacles that can be imagined: a human being in fear and doubt who is openly exploited to believe in the impossible. In the argument over prayer, then, please do not be shocked if it is we atheists who wear the pitying look as any moment of moral crisis threatens to draw near.
I figure she should take care of herself, put herself in a deep freeze, and in a year or two in all likelihood they’ll develop a pill that’ll clear this up simple as a common cold. Already, you know, some of these cortisones; but the doctor tells us they don’t know but what the side effects may be worse. You know: the big C. My figuring is, take the chance, they’re just about ready to lick cancer anyway and with these transplants pretty soon they can replace your whole insides.
— Mr.Angstrom Sr. in John Updike’s
Rabbit Redux
(1971)
U
PDIKE ’S NOVEL WAS SET IN WHAT MIGHT BE
called the optimistic years of the Nixon administration: the time of the Apollo mission and the birth of that all–American can-do expression that begins, “If we can put a man on the moon . . .” In January 1971, Senators Kennedy and Javits sponsored the “Conquest of Cancer Act,” and by December of that year Richard Nixon had signed something like it into law, along with huge federal appropriations. The talk was all of a “War on Cancer.”
Four decades later, those other glorious “wars,” on poverty and drugs and terror, combine to mock such rhetoric, and, as often as I am encouraged to “battle” my own tumor, I can’t shake the feeling that it is the cancer that is making war on me. The dread with which it is discussed—“the big C”—is still almost superstitious. So is the ever whispered hope of a new treatment or cure.
In her famous essay on Hollywood, Pauline Kael described it as a place where you could die of encouragement. That may still be true of Tinseltown; in Tumortown you sometimes feel that you may expire from sheer
advice
. A lot of it comes free and unsolicited. I must, without delay, begin ingesting the granulated essence of the peach pit (or is it the apricot?), a sovereign remedy known to ancient civilizations but now covered up by greedy modern doctors. Another correspondent urges heaping doses of testosterone supplements, perhaps as a morale-booster. Or I must find ways of opening certain chakras and putting myself in an appropriately receptive mental state. Macrobiotic or vegan diets will be all I require for nourishment during this experience. And don’t laugh at poor old Mr. Angstrom above: Somebody has written to me from a famous university to suggest that I have myself cryonically or cryogenically frozen against the day when the magic bullet, or whatever it is, has been devised. (When I failed to reply to this, I got a second missive, suggesting that I freeze at least my brain so that its cortex could be appreciated by posterity. Well, I mean to say, gosh, thanks awfully.) As against all that, I did get a kind note from a Cheyenne–Arapaho friend of mine, saying that everyone she knew who had resorted to tribal remedies had died almost immediately, and suggesting that if I was offered any Native American medicines I should “move as fast as possible in the opposite direction.” Some advice can actually be taken.
Even in the world of sanity and modernity, though, it often cannot. Extremely well–informed people also get in touch to insist that there is really only one doctor, or only one clinic. These physicians and facilities are as far apart as Cleveland and Kyoto. Even if I had possession of my own aircraft, I would never be able to assure myself that I had tried everyone, let alone everything. The citizens of Tumortown are forever assailed with cures, and rumors of cures. I actually did take myself to one grand
palazzo
of a clinic in the richer part of the stricken city, which I will not name because all I got from it was a long and dull exposition of what I already knew plus (while lying on one of the fabled establishment’s examination tables) a bugbite that briefly doubled the size of my left hand: completely surplus even to my pre–cancerous requirements but a real irritation to someone with a chemically corroded immune system.
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.
