The Way We Die Now (15 page)

Hitchens’s beliefs about his advanced cancer and its treatment were, for a man whose fame rested on his scepticism, uncharacteristically optimistic. While he admitted that he would be very lucky to survive, he steadfastly hoped, right to the end, that his particular case of advanced cancer might lie on the right side of the bell-shaped curve of survival statistics. He famously mocked religious folk for their faith in supernatural entities and survival of the soul after bodily death, yet the views expressed in
Mortality
are just as wishful. ‘The oncology bargain’, wrote Hitchens, ‘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.’ Over the years, I have diagnosed many patients with oesophageal cancer. ‘Years’ is a word not generally used when discussing prognosis in stage IV oesophageal cancer; ‘months’, in my experience, is a more pertinent term.

Although Hitchens was bracingly dismissive of the absurd notion of ‘battling cancer’, he was childlike in his enthusiasm for modern American oncology: ‘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.’ He contacts Dr Restifo, who responds enthusiastically: ‘Some of this may sound like space-age medicine, 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.’ Hitchens’s hopes were dashed, however, when it turned out that his immune cells did not express a particular molecule (HLA-A2) which must be present for this pioneering treatment to work: ‘I can’t forget the feeling of flatness that I experienced when I received the news.’

His hopes were raised again when he was emailed by ‘perhaps fifty friends’ about a television programme called
60 Minutes
, which ‘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.’ Hitchens’s friend, Francis Collins, molecular biologist and devout Christian, head of the Human Genome Project, ‘gently but firmly told me that my cancer had spread too far beyond my esophagus to be treatable by such a means’. Ironically, it is the Christian who had to lower the expectations of the sceptical atheist. Hitchens proposed to Collins that his entire DNA, along with that of his tumour, be ‘sequenced’, ‘even though its likely efficacy lies at the outer limits of probability’. Collins was circumspect, conceding that if such ‘sequencing’ was performed, ‘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 – that is at the very frontier of cancer research right now.’ Collins pointed out a more prosaic reason for not having his genome ‘sequenced’, namely that ‘the cost of having it done is also very steep at the moment’.

Mortality
contains vintage Hitchensian demolitions of such received wisdoms as ‘battling’ cancer:

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.

He dismissed this notion of struggle: ‘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.’ An admirer of Nietzsche, he came to realize that the dictum ‘that which doesn’t kill me makes me stronger’ is nonsense: ‘In the brute physical world, and the one encompassed by medicine, there are all too many things that could kill you, don’t kill you, and then leave you considerably weaker.’ Despite this, Hitchens remained optimistic, and he was strongly encouraged in his optimism: ‘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”.’ His wife Carol Blue and his closest friend Martin Amis shared this optimism. Amis, interviewed some months after Hitchens’s death, answered a question about his reasons for moving to New York: ‘At this point, it looked as though Christopher might well live for
five or ten years more
[my italics].’

Mortality
closes with an Afterword by Carol Blue, who writes: ‘Christopher was aiming to be among the 5 to 20 per cent of those who could be cured (the odds depended on what doctor we talked to and how they interpreted the scans).’ I wonder how his doctors could have given a man with stage IV oesophageal cancer such expectations of long-term survival, let alone a one in five chance of cure (which is about the survival chances for
all
oesophageal cancers, the lucky ones being those with very early, localized disease, not those with metastases in their lungs and lymph nodes). Carol Blue continues: ‘Without ever deceiving himself about his medical condition, and without ever allowing me to entertain illusions about his prospects for survival, he responded to every bit of clinical and statistical good news with a radical, childlike hope.’

Hitchens recalled the absurd quixotic optimism of the Nixon-era ‘War on Cancer’, when America, fresh from conquering the moon, decided that the ‘big C’ was next. Nixon officially declared war on cancer in 1971, and confidently predicted ‘complete victory’ by 1976. No matter that declaring war on cancer makes as much sense as declaring war on death. No matter that cancer is not one, but hundreds of different diseases. Hitchens quoted a wickedly funny line from Updike’s
Rabbit Redux
, where Mr Angstrom Senior declares: ‘they’re just about to lick cancer anyway and with these transplants pretty soon they can replace your whole insides.’ He is assailed with well-meaning suggestions: ‘in Tumortown you sometimes feel that you may expire from sheer
advice
’. He is wonderfully dismissive of ‘natural’ therapies: ‘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”.’

A correspondent from an (unnamed) university advised Hitchens to have himself ‘cryogenically frozen against the day when the magic bullet, or whatever it is, has been devised’. This particular nonsense is a rather spooky modern echo of the Christian belief in resurrection, a parallel that Hitchens surprisingly failed to spot.

Inevitably, somebody as well connected as Hitchens was advised to see the top man (or woman): ‘Extremely well-informed people also get in touch to insist that there is really only one doctor, or only one clinic.’ (A contemporary equivalent of the medieval visitations to holy shrines and relics?) He admits that he did take up this advice: ‘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...’

Only a man with stage IV cancer himself could, with impunity, skewer the sickly sentimentality of the late Randy Pausch’s
The Last Lecture
(2008). Pausch, a professor of computer science at Carnegie Mellon University, was diagnosed with terminal pancreatic cancer and became an Internet sensation after his lecture was posted on YouTube. The lecture, delivered to a standing ovation at his university, was entitled ‘Really Achieving Your Childhood Dreams’. Pausch also treated his audience to a demonstration of his press-up technique. Hitchens was unmoved: ‘It ought to be an offence to be excruciating and unfunny in circumstances where your audience is almost morally obliged to enthuse.’

The late philosopher Sidney Hook was Hitchens’s anti-Pausch. Hook, taken seriously ill in old age, ‘began to reflect on the paradox that... he was able to avail himself of a historically unprecedented level of care, while at the same time being exposed to a degree of suffering that previous generations might not have been able to afford’. Hook, suffering from heart failure and a stroke, asked his doctor ‘to discontinue all life-supporting services or show me how to do it’. His doctor denied this request, and Hook survived.

Hook’s essay, ‘In Defense of Voluntary Euthanasia’, is the perfect antidote to Randy Pausch: ‘Having lived a full and relatively happy life, I would cheerfully accept the chance to be reborn, but certainly not to be reborn again as an infirm octogenarian.’ Hook coined the phrase ‘mattress graves of pain’ to describe the suffering of stroke victims, and concluded his piece with a quotation from the Roman Stoic Seneca: ‘the wise man will live as long as he ought, not as long as he can’.

But Hitchens did not adopt Hook’s non-interventionist stance. It could be argued that his approach to his cancer treatment was at odds with much that he previously professed to believe (or not believe) in. In
God Is Not Great
he coined the withering phrase ‘the tawdriness of the miraculous’. He summarized the views of David Hume approvingly:

A miracle is a disturbance or interruption in the expected and established course of things. This could involve anything from the sun rising in the west to an animal suddenly bursting into the recitation of verse. Very well, then, free will also involves decision. If you seem to witness such a thing, there are two possibilities. The first is that the laws of nature have been suspended (in your favour). The second is that you are under a misapprehension, or suffering from a delusion.

He followed this up with Ambrose Bierce’s definition of ‘prayer’: ‘a petition that the laws of nature be suspended in favour of the petitioner; himself confessedly unworthy’. His friends and his doctors might wish to remind themselves of what Hitchens wrote, in good health, in
God Is Not Great
: ‘Those who offer false consolation are false friends.’ In his memoir,
Hitch-22
, he was scathing of such wishful thinking: ‘I try to deny myself any illusions or delusions, and I think that this perhaps entitles me to try and deny the same to others, at least as long as they refuse to keep their fantasies to themselves.’

When Hitchens died at the MD Anderson Cancer Center in Houston, Texas, his wife was clearly not prepared: ‘The end was unexpected.’ In
Mortality,
she describes how Hitchens, still intubated after a bronchoscopy, and therefore unable to speak, scribbled notes for her, such as: ‘I’m staying here [in Houston] until I’m cured. And then I’m taking our families on a vacation to Bermuda.’ Interviewed on Australian television after his death, she said:

...it was not clear to his doctors or to us that he was dying. His very radical state-of-the art medical treatments had proved quite successful and the cancer was in abeyance... the oncologist said he was in the one per cent of people who would have been alive then and we hoped that he would either go into a long remission or certainly have quite a bit more time. He caught a very, very virulent pneumonia...

Asked by her interviewer whether Hitchens considered at that time ‘it might be the moment to let go?’, Blue answered: ‘No, not at all, actually, because he’d been given such a prognosis. When they did the follow-up scan basically it was black; no cancer was showing...’

Inevitably, I will be accused of tastelessness in my analysis of Christopher Hitchens’s cancer story. To that charge, I would say this: Hitchens made a career out of dissecting the inconsistencies of his opponents’ arguments, and might have made similar observations to mine, had the story been about somebody else. He believed passionately in the freedom to offend people. We should be wary, however, of mocking beliefs which we do not share. One man’s delusion and folly is another’s ‘radical, childlike hope’. As news of Hitchens’s cancer diagnosis first became widely known, evangelical Christians speculated on the Internet about whether or not his illness would lead to a religious conversion. In
Mortality
, Hitchens scoffed at the notion. But in his time of ‘living dyingly’, he did find a kind of faith. This was not a return to the Anglicanism of his upbringing, or the Judaism of his mother’s family. Hitchens, the arch-mocker, the debunker of myth, found solace and consolation in the contemporary rites of genetics and oncology.

Susan Sontag (1933–2004), the American essayist, critic and novelist, did not go gently into that good night. She had – rather miraculously – survived advanced breast cancer in the 1970s, then uterine sarcoma in the 1990s, before finally succumbing to myelodysplastic syndrome (MDS), a type of bone marrow cancer. She had written about sickness in
Illness as Metaphor
and
AIDS and Its Metaphors. Swimming in a Sea of Death
(2008), the memoir written by her son David Rieff, begins with the diagnosis of MDS. Sontag and her son visit ‘Dr A’ in his office to receive the bad news:

MDS, he explained, slowly and deliberately, as if he had a family of village idiots sitting in front of him, was a particularly lethal form of blood cancer. [I felt for Dr A: ‘slowly and deliberately’ is how we’re taught to impart bad news, regardless of whether the interlocutor is a famous author, or, indeed, a village idiot.]... ‘So what you’re telling me,’ she finally said, with a poignant deliberation that makes me gasp even remembering it, ‘is that in fact there is nothing to be done.’ After a pause, she added, ‘Nothing I can do.’ Dr A did not answer directly, but his silence was, as the cliché goes, eloquent.

Sontag was not willing to accept this prognosis. After all, hadn’t she confounded her doctors back in the 1970s, when she had advanced breast cancer? She had initially undergone radical surgery in New York, and then tracked down a French breast cancer specialist, who prescribed a novel form of immunotherapy. Whether this immunotherapy cured Sontag or not is unclear; this form of treatment did not later go on to become standard therapy for breast cancer, so it seems unlikely. At any rate, her astounding good fortune instilled in Sontag an unshakeable faith in scientific medicine. The experience also gave her a sense of her own invincibility, a sense that must have grown stronger when she overcame cancer for a second time in the 1990s: ‘If you were supposed to die, and you live, in defiance of practically all the experts’ predictions and against all the odds, how can you not attach some meaning to what has occurred?’ But for all her attachment to science, Sontag had some flaky Reichian beliefs about the aetiology of cancer: ‘I’m responsible for my cancer. I lived as a coward, repressing my desire, my rage.’