A Salamander's Tale

by Paul Steinberg

  And let’s hold on to our celebrations, to help us revel in life and help us repress thoughts of death. Let’s hold onto Christmas, to Santa Claus, to Santeria, to festivals commemorating fall harvests—to anything that helps us celebrate life. Let’s hold onto our sacred music as well. Life without gospel music may not be a life worth living.

  But let’s separate these rituals and celebrations and music from the divine, from our previous conceptions of our monotheistic gods, from our books championing monotheism. Free at last, free at last.

  Apoptosis—the programmed death of all living cells—may be the key to understanding life and death. The gods have set up the universe in such a way that immortality leads to mortality. Every living cell is programmed to die; every cell in the human body is programmed to die, to be replaced by a new cell that will function just as well or better than the old dying cell. When a cell, however, has a gene or protein turned off that then allows the cell to live indefinitely, cancer develops. These immortal cells reproduce and take over the body. These immortal cells take the place of the mere mortal cells. These immortal cells kill the host, kill the person, kill themselves. These immortal cells cannot live without a host—a host that they have managed to destroy.

  The death of cells allows other cells to live. The death of each of us as separate human beings allows others to live. Again, a new kind of Malthusian world: We die so that others may live.

  Old and stale cells that live indefinitely, old and stale organisms that live indefinitely, old and stale collective wisdoms that live indefinitely: These represent the very definition of cancer. These old and stale cells and organisms and collective wisdoms are the embodiments of a world that is unable to regenerate, to refresh itself, to redeem itself.

  Only when we cling to life too ardently, only when we cling to power too ardently, only when we cling to past beliefs too ardently do we run into the accelerated death of our species. In allowing things and people and beliefs to die, we then find a way to live, to survive, to thrive. Yes, our species is programmed to die—but only by embracing our own eventual demise can we possibly extend the life of our species. Only by embracing the death of our previously cherished beliefs can we extend the life of our species. Only by embracing the contradictions and complementarities of life and death can we extend the life of our species. Only by embracing all of the current knowledge and wisdom of our society—and all its future knowledge—can we extend the life of our species.

  Another transcendent paradox: The ultimate regeneration, the ultimate redemption for a cell, for an organism, for a set of beliefs is death itself. For any element of life to regenerate and refresh itself, it has to die first. Apoptosis, or programmed cell death, rules our universe. When we defy apoptosis, a cancer is inevitable.

  A crucial note, a warning to atheists and agnostics: It is essential for you to make any renewal in religion and spirituality your business, even if you cannot believe in the quanta, in the photons, in the waves, in the gods. By dismissing this spirituality, by ignoring it, by wishing it away, by having contempt for it, you are inadvertent enablers of our current waves of fundamentalism. Not unlike many partners of alcoholics, you are ignoring and wishing away the craziness and drunken deludedness of your fellow travelers, the literalists and the fundamentalists. By putting your heads in the sand, you are allowing and enabling the craziest members of our planet to run the show. You cannot kill religions via nonreligion. The faith instinct tells us that only religion can kill religion. Yes, fight fire with fire.

  And find a way to engage with religion and spirituality. Make distinctions between a religiosity that is out of control and one that is manageable and in control—not unlike the spouse of a heavy-drinking partner who has to figure whether the partner’s drinking is out of control or manageable and responsible. An old Japanese proverb: first the man takes the drink, then the drink takes the drink, then the drink takes the man. Likewise, is religion taking over the man, or is the man still in control over his religion?

  Where do religion and spirituality fit into my own life? What the hell is a nice Jewish boy doing in talking about the end of the monotheism of his ancestors? For that matter, what was a nice Jewish boy doing in the surgical amphitheater of Columbia-Presbyterian Medical Center in New York City, anesthetized and having his pelvis torn apart on Yom Kippur day, October 5, 1984?

  I simply wanted to figure out where I fit into, and where our species and our planet fit into, the universe. Why do we live? Why do we die? Why do bad things happen to seemingly good people? Why do good things happen to apparently bad people? Why do drunken drivers have the right of way? Are we merely sheep being fattened up for the slaughter?

  Religion and spirituality are an effort to motivate ourselves in the midst of a battle, to inspire us, to help us face death, and to also face life. I have faced a remarkable foe in the form of prostate cancer. It has put up an exceptional battle; I have fought gamely as well. If it—this prostate cancer—does not win the battle, something else will kill me instead.

  Our battles can now become more personal, more individualized—sometimes, but not necessarily, community versus community, nation versus nation, region versus region, religion versus religion, ethnic tribe versus ethnic tribe, one -ism versus another ism. “He who conquers men has force, he who conquers himself is truly strong,” notes Lao Tse. I wish to have force and strength. I want to live with death and battle death. I want to live with prostate cancer and battle prostate cancer. I want to live with myself and battle myself. My cancer is me, and my cancer is not me.

  I wish to have a dialogue with the gods, with the quanta. I wish to give in to them and disturb them, to live with them and change them. I want a religious and spiritual perspective that helps me go into battle but not into battle necessarily with my enemies—instead, into a battle with disease, a battle with dying, a battle with death.

  I have no trouble with the military metaphors attached to cancer, despite the protestations of Susan Sontag in Illness as Metaphor. Yes, cancer is malignant and deadly. Yes, cancer is invasive. It infiltrates; it consumes; it takes over. It refuses to die; it only dies when it has killed the host organism. Yes, cancer kills, and cancer kills itself.

  So, I have no trouble with the notion of trying to kill and eviscerate and torch and nuke cancer cells. The cancer and I are in arched battle. I will use desperate and drastic measures to destroy this disease. “Diseases desperate grown by desperate appliance are relieved, or not at all,” Shakespeare reminds us. I will use nuclear force and poisons, not on my enemies, but on myself and on my own cells that otherwise refuse to die. I will use my dialogue with the gods, the quanta, to motivate me and mobilize me into battle. I will engage in my own war on cancer.

  We now have a way to channel our warlike natures—to turn our bellicosity and our warring impulses toward our own internal adversaries, toward our own genetic faults. We can battle against death and at the same time give in to death. Dying is as natural as living. None of us has to make any extra effort to die. We do not have to torch and nuke the planet. Like all of us, the planet can die its own natural death—without our assistance.

  I will fight the gods, or the quanta, and yet give in to the quanta. I will pray to the gods, to the quanta, to alter the path of these unseeable lumps of energy. I will make every effort to modify the wave I am riding, to shift its path, to reshape the arc of any downward curves, to alter my position and my velocity in this downward arc. At the same time I will give in to the natural trajectory of life and death when the quanta follow the expected path, when I am facing the ultimate point in that downward arc—death itself.

  Religion and faith and spirituality will always be with us. There is indeed a faith instinct, a religion impulse. Faith helps us go into battle, it helps us face illness and death, it helps us deal with the finiteness of life, it helps us try to figure out what happens after we die. So, I want to have faith—to have faith in the gods, in the quanta, in those infinitesimal lumps of ener
gy, in those waves that are also particles. I want to face death with the assistance of these gods, these quanta.

  A belief in the gods helps us to care less, to take the pressure off. No wonder athletes get together in a prayer circle before a major sporting event: It is all in the hands of the gods; it is beyond my control. I will do my best in this pursuit, but so much of life—so much of what happens in this sporting event or in life itself—is predetermined, is outside of my control. With the help of the gods, we move from the land of “choke”—the pressure to perform is overwhelming—to a point in which the stress level is manageable, to a point in which we can care less. With a belief that the gods, the quanta, the photons, are with us, we can care less. We can then function and perform at an optimal level.

  Whether facing an athletic contest or an illness or death, we can perform more effectively if we believe the gods are with us. We are not alone in this struggle. We can believe in the waves we are riding; we can let these waves take their course, without our trying too hard, without our pressuring ourselves too hard, without our working too hard to change these wave functions. We can fight loss and death, yet give in to loss and death at the same time. We can care about the outcome and at the same time care less.

  Let us not underestimate how crucial faith and religion can be for anyone who has grown up with punitive parenting, or with no parenting at all. A faith in the gods gives us another chance to be reparented—to project onto the gods a positive and caring presence that can provide a corrective emotional experience. As long as we can avoid any negative transference projections—the tendency to project onto the gods our negative and punitive experiences with parents and other authority figures—the gods in all their projected glorious positivity can help us become loving and caring partners and parents and work colleagues and friends.

  And let us not underestimate the value of a higher power in taking us away from forces like drugs and alcohol—from anything that has taken power over us, that has come to control our lives. We human beings instinctually need a sense that there is a power larger than ourselves, a power larger than drugs or alcohol, a power larger than cancer and disease, a power larger than life and death. As Bill W. and Dr. Bob have pointed out, it is invaluable to admit we are powerless, to be able to turn ourselves over to a higher power. The power of paradox: only with our acknowledgement of our powerlessness and helplessness do we gain power and liberation and control.

  And let us not underestimate the value of the religious impulse in helping us channel our obsessiveness and compulsiveness and superstitiousness. In the face of doubt and uncertainty and ambiguity, we have an inherent desire and need to reestablish some semblance of control. “If I do this or that, something good will happen; the gods will look favorably upon me.” Rain will come; health will come; victory over my adversaries will come; wealth will come. These beliefs and rituals are essential for our survival.

  A paraphrasing of the third step in Alcoholics Anonymous (A.A.) is vital as we move into the twenty-first century—to turn our will and our lives over to the care of gods as we understand them. Bill W. and Dr. Bob got it right. Our understanding of God or gods can evolve; our understanding of the gods and the universe is not static; our understanding of our planet does not remain stagnant and stale over the course of twenty-five hundred years. Our universe expands and evolves, our species expands and evolves, and our understanding of the gods expands and evolves.

  Is it lights-out when we die? The big sleep, the eternal sleep? Sukie Miller, a therapist who has studied how people think of death in various cultures, has noted that it is easier to die if we have a picture in our minds—coherent or incoherent, rational or irrational, it does not matter—of what happens in the after-death.

  Some elements of the after-death seem obvious to many of us: We do not remain full-bodied organisms that rise into the heavens or descend into the netherworld. We do not come back as other people or other species, plant or animal. Men do not find themselves in a blissful setting in which they are cavorting with seventy-two virgins. All of these are pleasant ideas that make death more palatable than it really is.

  Here’s my view—just as incoherent and irrational as any other view: We remain part of the quanta, we are lumps of energy, we continue to be waves and particles, affecting other waves and other particles—with no capacity for consciousness, no human or earthly capabilities. Whether we have been buried or burned after we die, we are still spirits and energies and qi—whatever name you wish to apply to it—that remain in the universe, still to be felt and experienced by people left behind. We do not have eyes or brains; we do not look down from above; we are not anthropomorphic entities watching our loved-ones’ every move. As if in a thought experiment a la Erwin Schroedinger and Albert Einstein, we are alive and dead at the same time, we have an impact here and there and everywhere—here on earth and on energy and particles perhaps millions of light-years away.

  In the meantime, as long as we remain alive, all we can do is remain vigilant, to recognize and observe and measure the malignancies among us—and to eliminate them if at all possible, or to find a way to keep them in check, or to manage to live with them if necessary. We can excise them; we can nuke them; we can poison them; we can even castrate them—anything we can do to reprogram cells and organisms to die and not live indefinitely. We can find a way to deal with the malignancies among us—malignancies that are grossly unaware of their own malignant nature.

  All I can do, with my prostate cancer and with any other limitations and infirmities that come along, is maintain my commitment to what Saul Bellow once bellowed, “that freedom to approach the marvelous which cannot be taken from us, the right, with grace, to make the most of what we have.” Or, as Tolstoy once extolled, “to love life in all its countless, inexhaustible manifestations.” To exult in the cockeyed cavalcade of life.

  I will follow the lead of that silver-tongued and silver-haired devil, Jimmy Dale Gilmore, the only singer-songwriter I know of who enjoys the whim of combining quantum physics with Buddhist teachings. Here is what my particles as waves are doing:

  Tonight I think I’m gonna go downtown,

  Tonight I think I’m gonna look around,

  For something I couldn’t see when this world was more real to me,

  Tonight I think I’m gonna go downtown.

  Whether dead or alive, we will all be going downtown and uptown at the same time. We will be going in all directions at once. Downtown, then uptown, then across town, from in-town to out-of-town, then from out-of-town to in-town, from the real to the unreal, from the unreal to the real. We are filled with infinite quanta; we follow infinite pathways. Keep riding the waves, keep disturbing the waves, keep enjoying the ride . . .

  CHAPTER 21

  The Wonders of Irony and Paradox and Ambiguity

  “The only thing that makes life possible is permanent, intolerable uncertainty; not knowing what comes next.”

  —Ursula LeGuin

  “It is not so much that there are ironies of history, it is that history itself is ironic. It is not that there are no certainties, it is that it is an absolute certainty that there are no certainties.”

  Christopher Hitchens, Hitch-22

  The purposefully ambiguous life. In facing the snares of prostate cancer, I became a world-class expert in dealing with ambiguity. No certitudes, no algorithms, no sureties. Flying by the seat of my pants.

  I was dealing with the first sign of a visible and palpable metastasis. It was May 2004, twenty years after my initial diagnosis, twenty years after surgery and radiation, fifteen years after my first clear-cut rise in the PSA, fifteen years after the first signs of invisible metastatic disease. I had been waiting for this day: Eventually the cancer will latch onto bone, spread into my lymph nodes, become visible. It has been lurking for two decades—ready to pounce.

  For the thirteen years since going on the intermittent androgen blockade, I had scanned my body whenever the PSA had risen to eight—just b
efore I re-induced the chemical castration. No signs of visible disease until now. Bone scans had been normal even though prostate cancer is notorious for spreading into the bone before locating itself anywhere else. CT scans had also shown no signs of disease.

  In May 2004, the bone scan was again normal. We physicians call this bone scan “negative”—meaning it is negative for any apparent disease—even though for the patient a negative bone scan is anything but negative. A sigh of relief—until I saw the CT scan of my chest. Although there was no sign of spread to my lymph nodes, there was a highly suspicious mass in my right lung. Not rounded, having rough edges, it was not a benign granuloma. This was a tumor mass—a cancerous mass, albeit relatively small.

  I heard a unified chorus. “Prostate cancer never goes to the lungs, especially in its first-ever metastasis,” said some prostate cancer experts whom my internist consulted with.

  “You have some kind of primary lung cancer until proven otherwise,” said a thoracic surgeon. Helen and I were sitting in his mahogany-walled office in downtown Washington, DC. He was looking at the CT scan. “This tumor is rather inaccessible. Not many surgeons can get to it. I am one of the few who can do it safely.”

  This guy’s confidence was breathtaking.

  Yet his reasoning and decision-making may have been half-baked. I did not doubt he had great hands, that he might be among the best at getting to inaccessible lung lesions. Did I want him, though, breaking a few ribs and splaying my lungs all over an operating table if the tumor was prostate cancer?

  Ah, “the wisdom of crowds.” I now had a phrase to describe what I had been doing for the past fifteen years. I refused to rely on one single expert. I called the Gerald Murphys, the Nicholas Bruchovskys. I consulted with experts from all over the US, from Canada, from different medical specialties—conventional experts, eccentric experts. My job was to aggregate the divergent opinions. Who could do it better than the person whose life was at stake?