I LOOK forward eagerly, almost greedily, to the weekly arrival of journals like Nature and Science, and turn at once to articles on the physical sciences — not, as perhaps I should, to articles on biology and medicine. It was the physical sciences that provided my first enchantment as a boy.
In a recent issue of Nature, there was a thrilling article by the Nobel Prize-winning physicist Frank Wilczek on a new way of calculating the slightly different masses of neutrons and protons. The new calculation confirms that neutrons are very slightly heavier than protons — the ratio of their masses being 939.56563 to 938.27231 — a trivial difference, one might think, but if it were otherwise the universe as we know it could never have developed. The ability to calculate this, Dr. Wilczek wrote, “encourages us to predict a future in which nuclear physics reaches the level of precision and versatility that atomic physics has already achieved” — a revolution that, alas, I will never see.
Francis Crick was convinced that “the hard problem” — understanding how the brain gives rise to consciousness — would be solved by 2030. “You will see it,” he often said to my neuroscientist friend Ralph, “and you may, too, Oliver, if you live to my age.” Crick lived to his late 80s, working and thinking about consciousness till the last. Ralph died prematurely, at age 52, and now I am terminally ill, at the age of 82. I have to say that I am not too exercised by “the hard problem” of consciousness — indeed, I do not see it as a problem at all; but I am sad that I will not see the new nuclear physics that Dr. Wilczek envisages, nor a thousand other breakthroughs in the physical and biological sciences.
A few weeks ago, in the country, far from the lights of the city, I saw the entire sky “powdered with stars” (in Milton’s words); such a sky, I imagined, could be seen only on high, dry plateaus like that of Atacama in Chile (where some of the world’s most powerful telescopes are). It was this celestial splendor that suddenly made me realize how little time, how little life, I had left. My sense of the heavens’ beauty, of eternity, was inseparably mixed for me with a sense of transience — and death.
I told my friends Kate and Allen, “I would like to see such a sky again when I am dying.”
“We’ll wheel you outside,” they said.
I have been comforted, since I wrote in February about having metastatic cancer, by the hundreds of letters I have received, the expressions of love and appreciation, and the sense that (despite everything) I may have lived a good and useful life. I remain very glad and grateful for all this — yet none of it hits me as did that night sky full of stars.
I have tended since early boyhood to deal with loss — losing people dear to me — by turning to the nonhuman. When I was sent away to a boarding school as a child of 6, at the outset of the Second World War, numbers became my friends; when I returned to London at 10, the elements and the periodic table became my companions. Times of stress throughout my life have led me to turn, or return, to the physical sciences, a world where there is no life, but also no death.
And now, at this juncture, when death is no longer an abstract concept, but a presence — an all-too-close, not-to-be-denied presence — I am again surrounding myself, as I did when I was a boy, with metals and minerals, little emblems of eternity. At one end of my writing table, I have element 81 in a charming box, sent to me by element-friends in England: It says, “Happy Thallium 鉈Birthday,”a souvenir of my 81st birthday last July; then, a realm devoted to lead, element 82, for my just celebrated 82nd birthday earlier this month. Here, too, is a little lead casket, containing element 90, thorium釷, crystalline thorium, as beautiful as diamonds, and, of course, radioactive — hence the lead casket.
At the start of the year, in the weeks after I learned that I had cancer, I felt pretty well, despite my liver being half-occupied by metastases. When the cancer in my liver was treated in February by the injection of tiny beads into the hepatic arteries — a procedure called embolization 栓塞 — I felt awful for a couple of weeks but then super well, charged with physical and mental energy. (The metastases had almost all been wiped out by the embolization.) I had been given not a remission, but an intermission, a time to deepen friendships, to see patients, to write, and to travel back to my homeland, England. People could scarcely believe at this time that I had a terminal condition, and I could easily forget it myself.
This sense of health and energy started to decline as May moved into June, but I was able to celebrate my 82nd birthday in style. (Auden used to say that one should always celebrate one’s birthday, no matter how one felt.) But now, I have some nausea and loss of appetite; chills in the day, sweats at night; and, above all, a pervasive tiredness, with sudden exhaustion if I overdo things. I continue to swim daily, but more slowly now, as I am beginning to feel a little short of breath. I could deny it before, but I know I am ill now. A CT scan on July 7 confirmed that the metastases 轉移 had not only regrown in my liver but had now spread beyond it as well.
I started a new sort of treatment — immunotherapy — last week. It is not without its hazards, but I hope it will give me a few more good months. But before beginning this, I wanted to have a little fun: a trip to North Carolina to see the wonderful lemur 狐猴 research center at Duke University. Lemurs are close to the ancestral stock from which all primates arose, and I am happy to think that one of my own ancestors, 50 million years ago, was a little tree-dwelling creature not so dissimilar to the lemurs of today. I love their leaping vitality, their inquisitive nature.
NEXT to the circle of lead on my table is the land of bismuth 鉍: naturally occurring bismuth from Australia; little limousine-shaped ingots of bismuth from a mine in Bolivia; bismuth slowly cooled from a melt to form beautiful iridescent crystals terraced like a Hopi village; and, in a nod to Euclid and the beauty of geometry, a cylinder and a sphere made of bismuth.
Bismuth is element 83. I do not think I will see my 83rd birthday, but I feel there is something hopeful, something encouraging, about having “83” around. Moreover, I have a soft spot for bismuth, a modest gray metal, often unregarded, ignored, even by metal lovers. My feeling as a doctor for the mistreated or marginalized extends into the inorganic world and finds a parallel in my feeling for bismuth.
I almost certainly will not see my polonium 釙(84th) birthday, nor would I want any polonium around, with its intense, murderous radioactivity. But then, at the other end of my table — my periodic table — I have a beautifully machined piece of beryllium 鈹(element 4) to remind me of my childhood, and of how long ago my soon-to-end life began.
He had determined that there was to be no conversation about her progressive cancer or the fact that she lay dying. Her experience was unacceptable yet the impasse dreadful and ethically troubling.I found myself thinking of a former patient who came into hospital dying of liver failure from metastatic bowel cancer. Her jaundiced skin was practically glowing and she had a resulting insatiable itch. There was not a single comfortable position she could find and it soon became clear that that she needed continuous sedation for comfort. But before I sedated her I needed to be sure that she understood her terminal condition, difficult given that the liver failure was causing agitation. The problem was that her husband was permanently stationed at her bedside and would not hear of me mentioning any bad news to the patient.