Throughout the course of his ordeal battling esophageal cancer, Hitchens adamantly and bravely refused the solace of religion, preferring to confront death with both eyes open. In this riveting account of his affliction, Hitchens poignantly describes the torments of illness, discusses its taboos, and explores how disease transforms experience and changes our relationship to the world around us. By turns personal and philosophical, Hitchens embraces the full panoply of human emotions as cancer invades his body and compels him to grapple with the enigma of death.
Mortality is the exemplary story of one man's refusal to cower in the face of the unknown, as well as a searching look at the human predicament. Crisp and vivid, veined throughout with penetrating intelligence, Hitchens's testament is a courageous and lucid work of literature, an affirmation of the dignity and worth of man.
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By Christopher Hitchens
TwelveCopyright © 2012 Christopher Hitchens
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I HAVE MORE THAN ONCE IN MY TIME WOKEN UP feeling like death. But nothing prepared me for the early morning in June when I came to consciousness feeling as if I were actually shackled to my own corpse. The whole cave of my chest and thorax seemed to have been hollowed out and then refilled with slow-drying cement. I could faintly hear myself breathe but could not manage to inflate my lungs. My heart was beating either much too much or much too little. Any movement, however slight, required forethought and planning. It took strenuous effort for me to cross the room of my New York hotel and summon the emergency services. They arrived with great dispatch and behaved with immense courtesy and professionalism. I had the time to wonder why they needed so many boots and helmets and so much heavy backup equipment, but now that I view the scene in retrospect I see it as a very gentle and firm deportation, taking me from the country of the well across the stark frontier that marks off the land of malady. Within a few hours, having had to do quite a lot of emergency work on my heart and my lungs, the physicians at this sad border post had shown me a few other postcards from the interior and told me that my immediate next stop would have to be with an oncologist. Some kind of shadow was throwing itself across the negatives.
The previous evening, I had been launching my latest book at a successful event in New Haven. The night of the terrible morning, I was supposed to go on The Daily Show with Jon Stewart and then appear at a sold-out event at the 92nd Street Y, on the Upper East Side, in conversation with Salman Rushdie. My very short-lived campaign of denial took this form: I would not cancel these appearances or let down my friends or miss the chance of selling a stack of books. I managed to pull off both gigs without anyone noticing anything amiss, though I did vomit two times, with an extraordinary combination of accuracy, neatness, violence, and profusion, just before each show. This is what citizens of the sick country do while they are still hopelessly clinging to their old domicile.
The new land is quite welcoming in its way. Everybody smiles encouragingly and there appears to be absolutely no racism. A generally egalitarian spirit prevails, and those who run the place have obviously got where they are on merit and hard work. As against that, the humor is a touch feeble and repetitive, there seems to be almost no talk of sex, and the cuisine is the worst of any destination I have ever visited. The country has a language of its own—a lingua franca that manages to be both dull and difficult and that contains names like ondansetron, for anti-nausea medication—as well as some unsettling gestures that require a bit of getting used to. For example, an official met for the first time may abruptly sink his fingers into your neck. That’s how I discovered that my cancer had spread to my lymph nodes, and that one of these deformed beauties—located on my right clavicle, or collarbone—was big enough to be seen and felt. It’s not at all good when your cancer is “palpable” from the outside. Especially when, as at this stage, they didn’t even know where the primary source was. Carcinoma works cunningly from the inside out. Detection and treatment often work more slowly and gropingly, from the outside in. Many needles were sunk into my clavicle area—“Tissue is the issue” being a hot slogan in the local Tumorville tongue—and I was told the biopsy results might take a week.
Working back from the cancer-ridden squamous cells that these first results disclosed, it took rather longer than that to discover the disagreeable truth. The word “metastasized” was the one in the report that first caught my eye, and ear. The alien had colonized a bit of my lung as well as quite a bit of my lymph node. And its original base of operations was located—had been located for quite some time—in my esophagus. My father had died, and very swiftly, too, of cancer of the esophagus. He was seventy-nine. I am sixty-one. In whatever kind of a “race” life may be, I have very abruptly become a finalist.
The notorious stage theory of Elisabeth Kübler-Ross, whereby one progresses from denial to rage through bargaining to depression and the eventual bliss of “acceptance,” hasn’t so far had much application to my case. In one way, I suppose, I have been “in denial” for some time, knowingly burning the candle at both ends and finding that it often gives a lovely light. But for precisely that reason, I can’t see myself smiting my brow with shock or hear myself whining about how it’s all so unfair: I have been taunting the Reaper into taking a free scythe in my direction and have now succumbed to something so predictable and banal that it bores even me. Rage would be beside the point for the same reason. Instead, I am badly oppressed by the gnawing sense of waste. I had real plans for my next decade and felt I’d worked hard enough to earn it. Will I really not live to see my children married? To watch the World Trade Center rise again? To read—if not indeed to write—the obituaries of elderly villains like Henry Kissinger and Joseph Ratzinger? But I understand this sort of non-thinking for what it is: sentimentality and self-pity. Of course my book hit the bestseller list on the day that I received the grimmest of news bulletins, and for that matter the last flight I took as a healthy-feeling person (to a fine, big audience at the Chicago Book Fair) was the one that made me a million-miler on United Airlines, with a lifetime of free upgrades to look forward to. But irony is my business and I just can’t see any ironies here: Would it be less poignant to get cancer on the day that my memoirs were remaindered as a box-office turkey, or that I was bounced from a coach-class flight and left on the tarmac? To the dumb question “Why me?” the cosmos barely bothers to return the reply: Why not?
The bargaining stage, though. Maybe there’s a loophole here. The oncology bargain is that, in return for at least the chance of a few more useful years, you agree to submit to chemotherapy and then, if you are lucky with that, to radiation or even surgery. So here’s the wager: You stick around for a bit, but in return we are going to need some things from you. These things may include your taste buds, your ability to concentrate, your ability to digest, and the hair on your head. This certainly appears to be a reasonable trade. Unfortunately, it also involves confronting one of the most appealing clichés in our language. You’ve heard it all right. People don’t have cancer: They are reported to be battling cancer. No well-wisher omits the combative image: You can beat this. It’s even in obituaries for cancer losers, as if one might reasonably say of someone that they died after a long and brave struggle with mortality. You don’t hear it about long-term sufferers from heart disease or kidney failure.
Myself, I love the imagery of struggle. I sometimes wish I were suffering in a good cause, or risking my life for the good of others, instead of just being a gravely endangered patient. Allow me to inform you, though, that when you sit in a room with a set of other finalists, and kindly people bring a huge transparent bag of poison and plug it into your arm, and you either read or don’t read a book while the venom sack gradually empties itself into your system, the image of the ardent soldier or revolutionary is the very last one that will occur to you. You feel swamped with passivity and impotence: dissolving in powerlessness like a sugar lump in water.
It’s quite something, this chemo-poison. It has caused me to lose about fourteen pounds, though without making me feel any lighter. It has cleared up a vicious rash on my shins that no doctor could ever name, let alone cure. (Some venom, to get rid of those furious red dots without a struggle.) Let it please be this mean and ruthless with the alien and its spreading dead-zone colonies. But as against that, the death-dealing stuff and life-preserving stuff have also made me strangely neuter. I was fairly reconciled to the loss of my hair, which began to come out in the shower in the first two weeks of treatment, and which I saved in a plastic bag so that it could help fill a floating dam in the Gulf of Mexico. But I wasn’t quite prepared for the way that my razor blade would suddenly go slipping pointlessly down my face, meeting no stubble. Or for the way that my newly smooth upper lip would begin to look as if it had undergone electrolysis, causing me to look a bit too much like somebody’s maiden auntie. (The chest hair that was once the toast of two continents hasn’t yet wilted, but so much of it was shaved off for various hospital incisions that it’s a rather patchy affair.) I feel upsettingly denatured. If Penélope Cruz were one of my nurses, I wouldn’t even notice. In the war against Thanatos, if we must term it a war, the immediate loss of Eros is a huge initial sacrifice.
These are my first raw reactions to being stricken. I am quietly resolved to resist bodily as best I can, even if only passively, and to seek the most advanced advice. My heart and blood pressure and many other registers are now strong again: Indeed, it occurs to me that if I didn’t have such a stout constitution I might have led a much healthier life thus far. Against me is the blind, emotionless alien, cheered on by some who have long wished me ill. But on the side of my continued life is a group of brilliant and selfless physicians plus an astonishing number of prayer groups. On both of these I hope to write next time if—as my father invariably said—I am spared.
WHEN I DESCRIBED THE TUMOR IN MY ESOPHAGUS as a “blind, emotionless alien,” I suppose that even I couldn’t help awarding it some of the qualities of a living thing. This at least I know to be a mistake: an instance of the pathetic fallacy (angry cloud, proud mountain, presumptuous little Beaujolais) by which we ascribe animate qualities to inanimate phenomena. To exist, a cancer needs a living organism, but it cannot ever become a living organism. Its whole malice—there I go again—lies in the fact that the “best” it can do is to die with its host. Either that or its host will find the measures with which to extirpate and outlive it.
But, as I knew before I became ill, there are some people for whom this explanation is unsatisfying. To them, a rodent carcinoma really is a dedicated, conscious agent—a slow-acting suicide-murderer—on a consecrated mission from heaven. You haven’t lived, if I can put it like this, until you have read contributions such as this on the websites of the faithful:
Who else feels Christopher Hitchens getting terminal throat cancer [sic] was God’s revenge for him using his voice to blaspheme him? Atheists like to ignore FACTS. They like to act like everything is a “coincidence.” Really? It’s just a “coincidence” [that] out of any part of his body, Christopher Hitchens got cancer in the one part of his body he used for blasphemy? Yeah, keep believing that, Atheists. He’s going to writhe in agony and pain and wither away to nothing and then die a horrible agonizing death, and THEN comes the real fun, when he’s sent to HELLFIRE forever to be tortured and set afire.
There are numerous passages in holy scripture and religious tradition that for centuries made this kind of gloating into a mainstream belief. Long before it concerned me particularly I had understood the obvious objections. First, which mere primate is so damn sure that he can know the mind of god? Second, would this anonymous author want his views to be read by my unoffending children, who are also being given a hard time in their way, and by the same god? Third, why not a thunderbolt for yours truly, or something similarly awe-inspiring? The vengeful deity has a sadly depleted arsenal if all he can think of is exactly the cancer that my age and former “lifestyle” would suggest that I got. Fourth, why cancer at all? Almost all men get cancer of the prostate if they live long enough: It’s an undignified thing but quite evenly distributed among saints and sinners, believers and unbelievers. If you maintain that god awards the appropriate cancers, you must also account for the numbers of infants who contract leukemia. Devout persons have died young and in pain. Betrand Russell and Voltaire, by contrast, remained spry until the end, as many psychopathic criminals and tyrants have also done. These visitations, then, seem awfully random. My so far uncancerous throat, let me rush to assure my Christian correspondent above, is not at all the only organ with which I have blasphemed. And even if my voice goes before I do, I shall continue to write polemics against religious delusions, at least until it’s hello darkness my old friend. In which case, why not cancer of the brain? As a terrified, half-aware imbecile, I might even scream for a priest at the close of business, though I hereby state while I am still lucid that the entity thus humiliating itself would not in fact be “me.” (Bear this in mind, in case of any later rumors or fabrications.)
The absorbing fact about being mortally sick is that you spend a good deal of time preparing yourself to die with some modicum of stoicism (and provision for loved ones), while being simultaneously and highly interested in the business of survival. This is a distinctly bizarre way of “living”—lawyers in the morning and doctors in the afternoon—and means that one has to exist even more than usual in a double frame of mind. The same is true, it seems, of those who pray for me. And most of these are just as “religious” as the chap who wants me to be tortured in the here and now—which I will be even if I eventually recover—and then tortured forever into the bargain if I don’t recover or, presumably and ultimately, even if I do.
Of the astonishing and flattering number of people who wrote to me when I fell so ill, very few failed to say one of two things. Either they assured me that they wouldn’t offend me by offering prayers or they tenderly insisted that they would pray anyway. Devotional websites consecrated special space to the question. (If you should read this in time, by all means keep in mind that September 20, 2010, has already been designated “Everybody Pray for Hitchens Day.”) Pat Archbold, at the National Catholic Register, and Deacon Greg Kandra were among the Roman Catholics who thought me a worthy object of prayer. Rabbi David Wolpe, author of Why Faith Matters and the leader of a major congregation in Los Angeles, said the same. He has been a debating partner of mine, as have several Protestant evangelical conservatives like Pastor Douglas Wilson of the New Saint Andrews College and Larry Taunton of the Fixed Point Foundation in Birmingham, Alabama. Both wrote to say that their assemblies were praying for me. And it was to them that it first occurred to me to write back, asking: Praying for what?
As with many of the Catholics who essentially pray for me to see the light as much as to get better, they were very honest. Salvation was the main point. “We are, to be sure, concerned for your health, too, but that is a very secondary consideration. ‘For what shall it profit a man if he gains the whole world and forfeits his own soul?’ [Matthew 16:26].” That was Larry Taunton. Pastor Wilson responded that when he heard the news he prayed for three things: that I would fight off the disease, that I would make myself right with eternity, and that the process would bring the two of us back into contact. He couldn’t resist adding rather puckishly that the third prayer had already been answered…
So there are some quite reputable Catholics, Jews, and Protestants who think that I might in some sense of the word be worth saving. The Muslim faction has been quieter. An Iranian friend has asked for a prayer to be said for me at the grave of Omar Khayyam, supreme poet of Persian freethinkers. The YouTube video announcing the day of intercession for me is accompanied by the song “I Think I See the Light,” performed by the same Cat Stevens who as “Yusuf Islam” once endorsed the hysterical Iranian theocratic call to murder my friend Salman Rushdie. (The banal lyrics of his pseudo-uplifting song, by the way, appear to be addressed to a chick.) And this apparent ecumenism has other contradictions, too. If I were to announce that I had suddenly converted to Catholicism, I know that Larry Taunton and Douglas Wilson would feel I had fallen into grievous error. On the other hand, if I were to join either of their Protestant evangelical groups, the followers of Rome would not think my soul was much safer than it is now, while a late-in-life decision to adhere to Judaism or Islam would inevitably lose me many prayers from both factions. I sympathize afresh with the mighty Voltaire, who, when badgered on his deathbed and urged to renounce the devil, murmured that this was no time to be making enemies.
The Danish physicist and Nobelist Niels Bohr once hung a horseshoe over his doorway. Appalled friends exclaimed that surely he didn’t put any trust in such pathetic superstition. “No, I don’t,” he replied with composure, “but apparently it works whether you believe in it or not.” That might be the safest conclusion. The most comprehensive investigation of the subject ever conducted—the “Study of the Therapeutic Effects of Intercessory Prayer,” of 2006, could find no correlation at all between the number and regularity of prayers offered and the likelihood that the person being prayed for would have improved chances. But it did find a small but interesting negative correlation, in that some patients suffered slight additional woe when they failed to manifest any improvement. They felt that they had disappointed their devoted supporters. And morale is another unquantifiable factor in survival. I now understand this better than I did when I first read it. An enormous number of secular and atheist friends have told me encouraging and flattering things like, “If anyone can beat this, you can”; “Cancer has no chance against someone like you”; “We know you can vanquish this.” On bad days, and even on better ones, such exhortations can have a vaguely depressing effect. If I check out, I’ll be letting all these comrades down. A different secular problem also occurs to me: What if I pulled through and the pious faction contentedly claimed that their prayers had been answered? That would somehow be irritating.
I have saved the best of the faithful until the last. Dr. Francis Collins is one of the greatest living Americans. He is the man who brought the Human Genome Project to completion, ahead of time and under budget, and who now directs the National Institutes of Health. In his work on the genetic origins of disorder, he helped decode the “misprints” that cause such calamities as cystic fibrosis and Huntington’s disease. He is working now on the amazing healing properties that are latent in stem cells and in “targeted” gene-based treatments. This great humanitarian is also a devotee of the work of C. S. Lewis and in his book The Language of God has set out the case for making science compatible with faith. (This small volume contains an admirably terse chapter informing fundamentalists that the argument about evolution is over, mainly because there is no argument.) I know Francis, too, from various public and private debates over religion. He has been kind enough to visit me in his own time and to discuss all sorts of novel treatments, only recently even imaginable, that might apply to my case. And let me put it this way: He hasn’t suggested prayer, and I in turn haven’t teased him about The Screwtape Letters. So those who want me to die in agony are really praying that the efforts of our most selfless Christian physician be thwarted. Who is Dr. Collins to interfere with the divine design? By a similar twist, those who want me to burn in hell are also mocking those kind religious folk who do not find me unsalvageably evil. I leave these paradoxes to those, friends and enemies, who still venerate the supernatural.
Excerpted from Mortality by Christopher Hitchens Copyright © 2012 by Christopher Hitchens. Excerpted by permission.
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His unworldly fluency never deserted him, his commitment was passionate, and he never deserted his trade. He was the consummate writer, the brilliant friend. In Walter Pater's famous phrase, he burned 'with this hard gem-like flame.'Right the the end.