Years, months, weeks

It would have taken me months to write many more essays. Years, probably, before I wrote a really good one. And it would have taken me forever to understand and figure out all that I wanted to understand and figure out.

But what I got are weeks.

The chemotherapy regimen I’ve been on, Gemcitabine, has stopped working. Blood tests show that my tumour-marker levels are rising. My pain is being managed well, but it is getting worse — it’s clear that my disease is advancing. And my appetite has diminished greatly; eating often hurts.

The most promising treatments are not all that promising. They are phase 1 clinical trials of drugs broad enough for any cancer, whose effectiveness is thus far only speculative and whose dosage has yet to be determined. So at this point, they’re more likely to do harm than good.

And because pancreatic cancer moves so quickly, what I got are weeks.

Before I had cancer, I too had years. And for the last year and a half, I had months. It was only logical that it would turn into weeks at some point. And so it happens now.

Marcus Aurelius once asked himself how he would react if a god told him that he would either die tomorrow or the day after. And he couldn’t see what difference it would make.



Is dying a transformative experience?

When you hear that someone has been diagnosed with terminal cancer, it isn’t too hard to be philosophical about it:

  • “That’s awful. But such is life.”
  • “Misfortune can befall any of us, can’t it?”
  • “We never know when our time is up. We must do what we can to live the life we’ve got and appreciate it as we go.”

But when you hear that you have terminal cancer, you think: “Fuck, fuck, fuck. Why is life so fucking unfair?”

In 1974, the philosopher Thomas Nagel wrote a famous paper called “What is it like to be bat?”1 In it, he made the observation that a bat experiences the world probably quite differently from the way we experience the world. And he argued that, in fact, a bat’s experience is so different that we, being human, cannot in principle know what it’s like to be a bat. We can imagine ourselves hanging upside down, eating bugs, using sonar to navigate, and so on. But we’re doing just that: imagining ourselves doing the things bats do. What we’re not doing is imagining what it’s like to be a bat.

This difficulty, of imagining what it’s like to be another creature, is not just there between a human and a bat; it’s there between any two creatures, even when they’re members of the same species. I can imagine, if I try hard enough, what it’s like for me to be in your shoes. But can I imagine what it’s like for me to be you in your shoes? I can imagine myself living your kind of life, but I can’t really imagine what it’s like for you to live your kind of life.

We relate to each other because we have something in common. That’s why it is hard to a relate to a bat, or people who are very different from us. I think this is why small talk exists. If you and I can talk about the weather, then there’s something we can agree on. Now that we’ve established that we have something in common, we can relate to each other.

Deeper connections between two people, though, need more than small talk. They need ground that is not only common but important to both of them. Think of those who share a common struggle: players on a sports team, soldiers in a platoon, students in graduate school. Many of these relationships do not last when the individuals no longer share the same goal, for example, when a player gets traded or when a student drops out of school. Some friendships do last, long after the shared purpose has ended — when the war is over, for example. But the friendships between soldiers persist largely because the history they share matters to who they are now. Few veterans leave that consequential aspect of their lives out of their self-conception.

And those who have been friends for a long time often choose to talk about the past rather than the present. It’s the past we still have in common. And it’s the past we rely on, even when everything in our lives seem to change. We change beyond recognition, and yet, when we get together, we talk about that time we fit all eight of us in the car and Sam, god bless him, volunteered to ride in the trunk.

There’s a gap between us that we don’t want to shed light on. Some things stay the same, but many things do not. What we have in common becomes increasingly diluted by the new important things in our lives: our marriages, our children, our divorces, our new careers, our recent struggles. We think if we put in enough effort, we can imagine what our friends go through. We can imagine what it’s like to have children (or we can remember what it’s like not to have children) and if we try hard to enough to imagine (or to remember), our friendships can still grow.

But here’s where Nagel’s bat swoops in. I don’t know if I can imagine what it’s like to have children. And I don’t know if you can imagine what it’s like to have terminal cancer.

The philosopher L.A. Paul has recently argued that becoming a parent is what she calls a transformative experience.2 This may sound like some purple poetic expression, but it’s a technical term and she means something specific by it. For an experience to count as transformative, (1) you have to learn something you could not have learned without having had that experience, and (2) after having had that experience, you think of yourself differently, or orient your life according to different values. This means that you cannot imagine what it’s like to have a transformative experience, because otherwise it wouldn’t be transformative: the experience tranforms you so much that you are now a different person and you could not have known how you would be different beforehand.

I don’t know if becoming a parent is really, truly a transformative experience, but it probably comes as close as anything. My wife and I tried to have children, but luck again wasn’t on our side. So I will never know what it’s like to have children. I do not know how it would have changed me and what I care about. If you think I’m trying to make this sound sad, I should let you know that Paul is clear in saying that transformative experiences are not inherently positive or, for that matter, inherently negative. It isn’t necessarily good or bad to have them. Precisely because they change you, you cannot know if they are good or bad: if we have not had a transformative experience, we cannot say that it would be good or bad to have it, since we do not know what it’s like; and if an experience changes us fundamentally, we cannot say that it was good or bad for us since we cannot compare it with how things were before since we no longer see things the way we used to.

I don’t know if having a terminal illness is a transformative experience either. Other than hearing the words “it’s incurable” or “your prognosis is months”, being as sick as I am bears no unique phenomenological experiences. There is no sensation to dying (at least not yet). There’s pain, to be sure, and the pain feels different and I feel it in strange new places. But the pain doesn’t tell you it’s dying pain. There’s fatigue also, but we’ve all been tired before. And now, just because it lasts longer and persists despite the usual remedies, the tiredness doesn’t tell you that you’re dying. There are also side effects in treating the illness, but none of those tell you that you are dying either. After all, the same treatment with the same side effects is given to those for whom the disease is still curable. All this probably explains why so many of us do not accept our fates — having one’s illness be terminal doesn’t feel like anything special at all.

There’s only this to the experience: the recurring and constant pain, the fatigue that lasts for days on end, over and over again, the nausea and the headaches, and the ever increasing portion of your time spent inside pharmacies and hospitals, going to them, coming back from them, with doctors and nurses and other people there to help you, with tubes and needles, putting fluids inside you while extracting others. My illness has become my life, or at least a large part of it. But those who have terrible but curable illnesses also live this kind of life.

So what tells me I’m dying? There’s no gut feeling — no gut knowledge that I only have so much time. There’s just my doctors’ words buttressed by data that only they can intelligibly interpret. (One might take all this as reason for me to distrust my doctor and hew my own way. But what it really shows is my unavoidable dependence on experts and how there’s only so much epistemological value to my feelings.) But there is something to knowing that you have a disease that’s going to kill you soon. If you accept that fact, and acknowledge it deep down and in all the things you do, I think it does transform you.

The young prefer spending their time meeting new people over spending it with those they already know well. They are preoccupied by questions such as, “what will I do next?”, “will I become successful?”, “what should I do to become successful?”, “will I find my soulmate?” But the elderly, it seems, are different: they prefer to spend their time with family rather than strangers, and with old friends rather than trying to make new ones. And because they know their time is limited, they want to spend it on everyday pleasures and the people they know they already love.3

When I was young, my family and I would make a yearly visit to New Jersey where my great aunt and her family lived. We would stay there for a week or so and play around their large house, as my mom’s extended family would dote on us. But whenever it was time for us to go, to begin our journey back home to Montreal, my mom’s aunt would cry. She was always a little frail, and I had wondered then, as I wonder now, if she was preparing herself to say goodbye for the very last time.

I do that too now. Friends visit from far away, and I wonder if it’s the last time I will ever see them. Friends talk about visiting me in four or five months, and I wonder if I’ll be around to receive them. I went to McDonalds a few weeks ago — I have a small but special fondness for the place — and I wondered if it was the last time I’d ever eat there. Epictetus counselled that we do that on purpose: we should try to imagine each meeting with a loved one, each experiencing of an ordinary pleasure, as possibly our last, even when we’re not terminally ill, so that we may learn to appreciate what we have and not dwell too much on what we don’t. He thought it would change us for the better. I have tried to follow his advice for many years, long before I was sick. But it was hard to do in any real capacity. Now it has become part of my everyday. I’m no longer sure if Epictetus is right about whether this practice changes us for the better. But I do think it changes us.

So what this means is that there is this gap between me, who is dying, and you, who are not. If you are young, you still want to do things that can shape the rest of your life. If you are older or if you are sick like me, you might not care so much to shape the rest of your life as much as to live it and appreciate what you can. These differences between us are unavoidable and understandable. But it means that no matter how much some of you are there for me, I still feel alone. You do not know what it’s like to be dying, and you probably can’t know, until it happens to you.

I suppose this is why support groups exist. Only other people who are living with cancer knows what it’s like to live with cancer. Only others facing a terminal illness really know what it’s like to face a terminal illness. And when I go to these support groups, I do feel less alone. But only for a short while. Not everyone at a support group is dying, and not every dying person accepts that they’re dying. But more to the point, these people are not my friends or my family, and, being short on time, I’m not interested in making new friends.

I’m not the only one this illness has transformed. It has turned my wife into someone whose husband is dying. And it will eventually turn my wife into a widow. I do not and cannot know what it’s like to watch your husband or wife suffer through this illness, and I will not know and cannot know what it’s like to lose the love of my life. I can only imagine what it’s like for her now and what it will be like for her then, and she can only imagine what it’s like for me – and we both know that such imaginings can only give us the barest outline of what our experiences are like. There are two of us transformed by this illness, but in different ways. My wife and I are both left a little alone by this illness, left incompletely understood, even by each other.

But despite that, we are here for each other. And even if none of my friends and family really understand what it’s like to be dying or what it’s like to have a husband who’s dying, they are here for us — unwavering and stalwart. Now that life seems so fragile and short to me, all this seems like a wonder.

  1. Here’s a link to Nagel’s article. ↩︎
  2. See Paul’s “What You Can’t Expect When You’re Expecting” and “Précis of Transformative Experience both available on her website. ↩︎
  3. See Chapter 4 of Being Mortal by Atul Gawande. ↩︎

On being calm about death

Near the end of the original Star Wars movie, Obi-Wan Kenobi, the wise Jedi elder, smiles just before closing his eyes and allowing himself to be struck down by the evil Darth Vader. His face reveals a moment of calmness and acceptance at the moment of death.

Something similar happens at the end of Batman Begins. Ra’s Al Ghul, Batman’s evil but wise mentor, closes his eyes and meditates when his death becomes unavoidable.

The lesson seems to be that the wise are calm at the moment of death. This is not a new idea created and perpetuated by cool Hollywood movies. It is actually rather old.

In the Apology, Plato describes Socrates as accepting his punishment upon death by willingly drinking the poisonous hemlock he is given. And it’s not just in his willingness to die that Socrates is calm, but also in the process of dying. According to Plato, Socrates is aware of how his body dies moment by moment: his limbs go numb first, followed by his torso, and last of all his voice, from which his wise words emanate.

But this description of his death is probably a lie. Hemlock does not make one go numb. Instead it makes one vomit and tremble, among other symptoms, resulting in a painful death. Now one philosopher has gone to great lengths to argue that Plato’s description was, in fact, accurate. But what is interesting to me is why this is an important matter at all, why is calmly dying so important to our image of wisdom?

Let us compare our reaction to Plato’s account of Socrates’ death to our reaction to someone losing their mental and voluntary faculties long before they die. We notice a difference. The first situation inspires awe and respect, and the second, sadness and pity.

I think we should be sceptical of these images of wisdom. Dementia is real and common among the elderly as are serious changes in one’s personality. Someone who was wise and calm in life may turn into a raving and incoherent lunatic before they die. And because one is inextricably subject to the caprices of one’s physical body (including the brain), the moments of one’s death may conceal and obscure rather than reveal who one really was.

But Socrates’ calmness regarding death goes beyond just the physical manifestations during his last minute. It’s present in what he says about death:

since no one knows whether death, which they in their fear apprehend to be the greatest evil, may not be the greatest good….. I will never fear or avoid a possible good rather than a certain evil.

This is the logic of his thinking, one couched in terms of hope. The idea seems to be that if we do not know for certain that X will be bad, then there is a possibility that X is good, and thus we should not fear X. And to think that we can know for certain that X is bad is to think we know more than we actually do, which is the hallmark characteristic of a lack of wisdom. Thus, being wise means not fearing death.

This argument is flawed. For one, it is too strong. If we believe that certainty in most knowledge is impossible, as many of us do, it means that we should never be afraid of anything at all, even if it means falling into a pit of lava. We may be fairly confident that it will be very painful, but we cannot know that for certain, for random miraculous things can happen during our descent into the pit.

And we can also question the very premise of this argument — that we should hope when there is a possibility of a good outcome and only fear when there is a certainty of a bad outcome. But why? Why not fear when there is a possibility of a bad outcome, and only hope when there is a certainty of a good outcome?

But more importantly, Socrates’s way of thinking is entirely unBayesian. In particular, it’s far too binary and too extreme. According to Socrates, we should hope when there is even the smallest possibility of a good outcome, and we should fear only when there is certainty of a bad outcome. But this precludes the possibility of having mixtures of fear and hope. Can I not say that I hope 30% that this will be good, but 70% fear that this will be bad? Maybe this doesn’t make sense of our psychology, for it does not describe how we actually think — maybe we cannot have both emotions of fear and hope simultaneously. But there is no logical error in thinking that A is 30% likely, and not-A is 70% likely. In fact, it is more nuanced and precise than simply saying that something is “possible” or “a good chance”. And when we think this way, in terms of assigning likelihoods, how do we conceive of hope and fear? I’m not sure, but we have to abandon Socrates’s approach.

The point of all this is really to ask why we should be calm at the moment of death. For Socrates, it made sense to be hopeful, because one doesn’t know what will happen and what happen might be good. That argument, as I’ve tried to show, is rather ineffective.

There is at least one other reason for Socrates’s calmness. For instance, he didn’t just believe that we did not know that death would be bad, but he believed that the death of the body did not mean the death of the person. In short, he believed in the immortality of the soul. And so did Obi-Wan Kenobi, from Star Wars. I’m not sure about Ra’s Al Ghul, but most depictions of mystical wise men portray a faith in the afterlife, and this faith grounds their calmness. I’m not going to argue for this, but I don’t think an afterlife is likely.

So are there any other reasons to be calm at death? One reason might be that it is somehow inherent in wisdom to be calm. But this is a terrible answer. If there are good reasons to be calm, then it is wise to be calm. And if there are no good reasons to be calm, then it is not wise to be calm. Wisdom is not something that exists apart from being able to have and act for good reasons. In other words, to say that one reason to be calm at death is that it is wise to be so is to say very little.

I can only think of one good reason to be calm at death, but the reason is not so strong that if you fail to be calm at death you would somehow lose the title of being wise. The one good reason I can think of is this: it’s generally more pleasant to be calm than to be agitated, and so this is probably true at the moment of dying too. That’s it. It’s a pretty weak claim.

So it’s a good idea to be calm at death, but it’s no big deal if you’re not.


My fear of dying

We are afraid of dying, so afraid that we avoid talking about it, avoid thinking about it, avoid confronting the unfortunate fact that we all die. What makes this so astonishing is that death surrounds us: “dead leaves, insects and pets, disappearing grandparents, grieving parents, endless acres of cemetery tombstones.”1 And something — a plant, an animal — must have died whenever we eat.

We divert our attention away from it; we want look at anything but death itself. And when we can look at it, we think of it as something that happens to others, even though we know, somewhere in the back of our minds, that it happens to us all. We refuse to infer and acknowledge consciously the terrifying conclusion that “because I am human, I too will die.”

Even as a philosopher, I have never fully faced up to this fact. I thought I had. But now, in the face of my own death,2 I realize that I haven’t. I did try, though. I’ve read books and papers on the philosophy of death, and I’ve tried to think through the consequences of dying and what it means to live such a short time in comparison to what time there is.

In the context of what is called “contemporary history”, this is the part of it that I’ve been alive for:


I have lived a little over half of that period. If I include the projected lifespans of those who are my age, given the average life expectancy at birth is 71, the blue part is what the span of my life would look like.Image2

Looking at it this way, it feels like I’d miss out on a lot:Image3And if I were to include all of modern history, which starts roughly with 1500, it would like this:



The difference between my life (one with terminal cancer) and the lives of others my age begins to look negligible. If I include all of recorded human history, which started roughly in 4000 BC, it would look like this:



Here, we can barely see the difference between my ~39 years and another’s 71. In fact, my 39 years of existence would be about three pixels wide, and the average of 71 years would only be about six pixels wide.

If I include the entire span of the human race, which started roughly 200,000 years ago, it would look like this.



The difference is completely moot. And in fact, our lives wouldn’t even make up anything close to the size of a pixel. (Check out all those arrows pointing at the same damn tiny spot.)

And let’s look into the future and from several magnitudes higher. In a billion years, the sun will get too hot for all but the simplest of life forms. The entire existence of the human race itself, until 2049, wouldn’t amount to only about a tenth of pixel on the screen.



If I include the beginning of the planet itself, the whole existence of humanity up to 2049 would amount to a quarter of a pixel.



We are surrounded by nothingness. We are, at best, blips in the span of all that will ever exist. And I haven’t even drawn a graph of our lives within the span of the age of the universe.3

But now facing the truth that I will die, I realize that I haven’t shed all the trivia and unwarranted assumptions of life. I still care, even if less so now, about what others think of me. I still get the momentary and pleasurable rush of a getting a “like” on social media. There is nothing evil or inherently bad about this, but it is a distraction from the things that matter.

Sometimes what I find difficult isn’t the fact that I will die soon, but the fact that other people continue their lives with unerring normality – as if everything were just the same. (How could it be otherwise? They have their own lives to live.) There is profound loneliness in this but also the futile urge to shake people out of their routine and out of their everyday mode. I know better than to try to do this, but I’ve tried anyway — and you probably noticed that’s what this post is about.

I want everyone to engage with life in the present, to make efforts for meaningful connections, to follow their own voices and listen to their own reason. But what do I really know about how to live your life? Maybe nothing. Just because I’m dying doesn’t mean I should be giving advice about how you ought to be or what you ought to do. But just for the same reason, I feel bold enough to try.

  1. Irving Yalom, Staring at the Sun
  2. For those of you new to this blog, I have a terminal cancer, specifically, stage IV pancreatic cancer. 
  3. I’ve tried to be make these diagrams to scale, but I haven’t double checked my calculations. 

How much time do I have left?

When I was first diagnosed with pancreatic cancer, I was given a terrifying number: 10. On average, someone diagnosed with Stage 4 pancreatic cancer has ten months to live.

And what sounds scary is the fact that I was given this statistic a little over seven months ago, which makes it sound like I have only about three months left to live.


But this logic isn’t right. I have survived the last seven months (actually, I’ve lived the last seven months intensely), and so the number I should be concerned with is not

  • “How many months, on average, does the diagnosed Stage 4 pancreatic cancer patient, who has just been diagnosed, have?”


  • “How many months, on average, does the Stage 4 pancreatic cancer patient, who is still alive after seven months, have?”

The answers to these two questions are different, because they take their averages from two different sets of people. To answer the first question, your set would include everyone who’s been diagnosed with Stage 4 pancreatic cancer. And that means including all the people who did not make it to seven months: those who died within one month after their diagnosis, two months after their diagnosis, and so on.

But to answer the second question, you would not include everyone. You would exclude all those people who died within seven months of their diagnosis. And so the average number of months this group of stage 4 pancreatic cancer should be higher. In other words, the answer to the question “how many months do I have left?” should be more than three months.

The difficult thing is that I have no idea what the answer to the second question is or how many more months I actually do have.

who knows.png

But I’ve recently got on good terms with uncertainty, which is a good thing, since uncertainty — about life and death no less — has forced its way to become my constant companion.


Changes to my body

My body has undergone many physical changes over the last 6 months, since my cancer diagnosis and my chemo began. I used to have hair on my head.

Screen Shot 2016-09-01 at 9.08.12 AM.png

Now I do not.

Screen Shot 2016-09-01 at 9.19.40 AM.png

All this from the chemotherapy.

I’ve also had a plastic triangular disc placed under the skin on my chest which allows for easier intravenous access for chemo drugs. I’ve also lot some weight. And those are just the changes one can see.

My treatment has also given me peripheral neuropathy, which means my fingers and toes tingle all the time.

Screen Shot 2016-09-01 at 9.22.44 AM.png

And the fatigue is persistent, and even as it wanes the further from my last treatment, it pops up unpredictably, causing me to end social engagements early, to leave my friends before I finish my coffee or tea, to leave parties well before the end, just so I can go home and sleep.

In all of this I have been fortunate—my body is continuing to respond well to treatment (relatively speaking). The cancer itself is having less effect on my body than it once did, despite still remaining my probable and eventual killer.

It’s difficult to deal with change, even if you recognize its inevitability and its pervasiveness. If you change one thing, and deal with that, that’s still hard but okay, especially if you are the change’s agent rather than its plaything.

A large, unshakeable, change will come to me swiftly at some point. The chemo will stop working, and the cancer will overtake my body and me. It will be fast—a matter of months. But it will also be slow—months are long. The cancer will bring fatigue down on me like rain. I will not burn out or end with a bang. Instead, I will whimper and fade away. My death will be pathetic.


I don’t want to die, but I will

The sadness I sometimes feel is just a result of this straightforward problem. I want something that I can’t have. The simplicity of this frustration is almost immature.

I’m hardly alone with this problem. The tension between what we want and what is going to happen is universal. It’s not just me. Almost all of don’t want to die, and all of us are going to (probably). There’s just an immediacy to my situation – I’m going to die sooner than most, and I don’t want to that to happen.

The wise advise against wanting something you can’t have – Buddhists, Stoics, whoever else. We must accept what is inevitable in order to live peacefully, with equanimity and calm. What good would it do, they ask, to want something impossible? What good would it do to resist change? How fruitful is it to rebel against nature?

And death, if it is anything at all, is natural. All living things die. That is about as universal a truth as you can get, without stepping into the abstract. It is a concrete reality, unfailing in its comprehensiveness.

But that death applies to all is only a statistical reality. It is a claim about how things have been thus far. There’s a tree, the Great Basin Bristlecone Pine, that is said to be over 5000 years old. Is it mortal? It can certainly die, from natural disaster or human ill will. But if it’s left alone, will it die at all?

Some might say that death is written in the laws of nature, but that, of course, is not literally true. The laws of nature are not written anywhere, not on any stone tablet, not in the holy books, not on the side of a mountain, not in the stars, not anywhere. And those who think they know the laws of nature are, I say, fools – fools for thinking they can rest assured in their supposed wisdom, fools for accepting ideologies as facts, fools for stifling their own curiosity with cliches. And yes, here I am, calling the Buddha a fool, Marcus Aurelius a fool, Yoda a fool, and all other holy men fools.

But I too am a fool. I want never to die; I want to live forever. This is about as foolish a wish that one could have. Nobody lives forever. Fact number one.