On the Night Side of Life: The Malady Spreads, the End Is Nigh

As a cancer doctor, what really stuck out to me was the author's deep anxiety and unsettled thoughts on his own death. I gather he loves life very much and meditating on this topic causes a lot of mental anguish. He is fearful and dreading the pain, financial, and social implcations effect of his death on himself and his family. He is unsure of his own resilience, calling his beautiful prose on the topic "virtue signaling", then later ending with a declaration of fortitude. All this I think adds to his suffering.

This despairing view of death is not inevitable. With all respect to the writer, who I do not know at all, I think perhaps his suffering comes from the illusion that through science we are, in a semblance, "in control." The fact that the patient "on [his] insistence", asked his doctor another round of chemotherapy is troubling to me. Chemotherapy is intrinsically designed to stop cellular replication, and may shorten life if a therapeutic ratio does not exist. But he wanted it - perhaps hoping it would make him live longer.

We are not in control of the central processes of life. We can at best tinker and nudge, and prolong life with the tools of science. Even "cures" for cancer result in a few decades more of life. Lazarus raised from the dead, lived a while longer and then died again.

So I try to guide my patients away from the concept of death as avoidable. Chemotherapy and radiation and surgery are just temporary fixes, nothing ultimate to put your hope in.

Death is inevitable, and can have meaning to it too. Yes the experience of death brings suffering, and fear, but also a time of reconciliation, clarity, and ultimately peace. Why is it this way? Faith in God and the afterlife is one answer, transcending the self is another, the quantum nature of space-time is another.

Any way you approach it, death is in the realm of metaphysics, incomprehensible and mysterious to our scientific worldview - and, I think importantly, reductive to assign a normative value as "bad."