How could it possibly be merciful of God to reduce you to the hyperawareness, every second of your waking life, that death is relentlessly approaching? Even if it is a knowledge that most other men and women do not have, regardless of what they may like to say, is it knowledge worth having?

Just so you understand: I am dying. I am in the end stage of metastatic prostate cancer, and after six-and-a-half years of close association with the disease, I have another six months to two years to live. That probably sounds exhibitionistic, but I don’t mean it to. Nor am I fish­ing for pity. Truth is, I’d sooner have your laughter.

Man says, “I’ve been diagnosed with terminal cancer, but I am going to fight it with everything I’ve got.” “My money’s on the cancer,” his friend says. Find me that friend.

When it is incurable, as mine is, cancer always wins in the end, but no one—I mean, no one—wants to hear any such thing. The preferred message in our culture is the sentimental one of hope. Hope is not, however, what the terminal cancer patient needs. Even if you believe in miracles, you cannot hope for one—not the way you hope the car’s skid comes to a stop before the cliff’s edge.

“By definition,” C. S. Lewis writes, “miracles must of course inter­rupt the usual course of Nature,” but if they were as common as mosquitoes in summer they wouldn’t be interruptions of the usual.

What cancer patients need more than anything is to take responsibility for their disease. From their doctors, from their family and friends, and especially from themselves, they need simple honesty about their condition, their treatment options, their chances. They require exactly what the psychological theorist Karen Horney said the neurotic requires if he is to grow as a human creature: the “square recognition of his being as he is, without minimizing or exaggerating.”

A cure may not be possible, but even in the face of death, moral and intellectual growth is. Susan Sontag was right, in Illness As Metaphor (1978), to object to the Victorian attitude toward consumption—that it was a narrowing of life to a focus upon what is good. There is nothing good about dying of cancer, especially when, as I do, you have four children under the age of eleven and a wife whom you lust after and adore.

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