FAITH JPPE

1 W. Pennington Speech for the Faith Hope Love Gala for Pancreatic Cancer 01.26.2019 I was asked this evening to speak about my “story.” Well, to be honest with you, my story isn’t particularly interesting. I was diagnosed with pancreatic adenocarcinoma in March of 2016; since then, I’ve gone through 9 rounds of the chemotherapy cocktail FOLFIRINOX, 5 rounds of stereotactic cyberknife radiation, a whipple surgery with partial pancreaduadectomy, 1 year of Capecitabine Xeloda, a second customized open-abdomen surgery, and 12 rounds of GemzarAbraxane. Throughout: creon, atavan, lovenox, Zofran, needles, IVs, tests, scans, nausea, darkness and blood. Would I do it all again? Eh, I happened to meet the love of my life through the process, the kind-of human being that makes any trudge through hell worth it, so my answer is a resounding, if not confusing “yes.” But beside that I have compiled this resume only to otherwise say: cancer is like a dream; avoid this dream at all costs.

But I have some inclination you already know that—hence why you are here tonight.

What I am much more interested in discussing, and I hope you will permit me your patience here, is outlining what I would call “our” story. If any speech worth its merit might be distilled down to one single point, I’ll be quite upfront with you: my purpose tonight is to show how our story, what we are doing here, is not some minor or arbitrary or even isolated effort against a horrendous disease, some blip on an otherwise silent radar. Our efforts here tonight rather reflect something a little more grand, if not harder to perceive. What I want to show you—and trust me, I know how juvenile a hypothesis like this may sound, but when you lock yourself in a bathroom after surgery for three months straight, in the dark, in the water, in the heat—well, you can stumble upon some pretty nutty ideas. So what I want to show you is how our story is woven into the momentum and thrust of this reality, how what we do here tonight is ordained by the very nature of things, that there is something to the great arc of our known history that has bent toward this very moment. I will show you, with you sitting there and me standing here, I will show you what it is that we are really doing tonight; I will show you how all that has come before us has made tonight sacred; I will show you, hopefully, something you haven’t quite seen before.

And so, with that, we greet our story at its very beginning.

Infectious disease was virtually unknown to early man. The bands of hunter gatherers that spread themselves out from the earliest river valleys were too few in population to sustain contagions; their foodstuffs were varied enough to avoid many of the nutritional deficiencies that we face today; and they often would die of natural causes long before degenerative disorders had a chance to set in. For all intents and purposes, the “sick body” would have been an alien and unfamiliar concept. And yet, archeology has shown an ancient companion to these nomads. It was a sickness, perhaps the oldest sickness, that traced itself upon misshapen, splintered and fractured bones. It was a sickness that early man would have confronted without explanation or name—a type of hazy darkness that pulsated with pain and punishment, a type of alien that grew inside him. One could only imagine how early man thought of himself and his body in these circumstances.

It was, ironically, mankind’s desire for the more permanent company of his brethren, his love for his fellow man, that would first introduce him to that vast invisible world we call “disease.” Forming more stable and less transient dwellings some 10,000 years ago, the domestication of animals, growth in human population, proximity of communal living and lack

2 of any and all sanitation produced the initial conditions of contagion. The “sick” body had now become a problem of human experience as it had never been before. And so it was that the project of civilization, from its very inception, thus became inextricably linked to that dark kingdom of disease, a dialectic that would go hand in hand, carving itself through centuries, first in this direction, then in that; now in this manner, later in another; winding and whispering and weaving itself, like the growth of a malignant tumor determined to live.

For the next eight millennia, mankind’s relation to disease slowly took conceptual form.

Early and ancient killers such as Typhus, smallpox and leprosy emerged from the deserts of northern Africa and plagued the first pharaohs. Even among these horrendous killers, however, cancer stood out. In 2625 BC, the great polymath Imhotep compiled one of the first medical registries every devised. Crude and simple in its taxonomy, nomenclature and list of remedies, Imhotep’s list consisted in 48 unique cases. Imhotep built a corresponding list of therapeutic remedies attached to each case. Though rudimentary, the breadth and creativity of Imhotep’s approach is astonishing: balms, ointments, tonics, bodily stretching and even dietary advice spilled out across Imhotep’s papyrus—save, that is, for case 45, described by Imhotep as a young man with large, black lumps across the chest, hard to the touch and solid, like “unripe hemat fruit.” For the myriad combinations Imhotep had devised for all 47 other cases, Imhotep’s list for case 45 was terse. Under therapies, Imhotep wrote “There is none”; Under name, Imhotep wrote ra-acktun-atiri, the emperor of all maladies.

From this cradle of civilization came the Assyrian kings—Nebuchadnezzar and Esarhaddon, who linked the concept of health, now part of the lexicon of unassumed human thought, to the legitimation of their political rule. Using extispacy, or the ritual killing of animals, often goats, and the reading of the liver, these early kings employed divine seers to sediment their power in the eyes of superstitious and restless populations. Since the human body was seen as a sacred thing, and its destruction a thing of blasphemy, the only surgical developments that would have occurred in this ancient period would have been through the vivisection of political animals. In some sense, there was a raw pragmatism to this linkage of the political, the sacred, and sickness: reliable crop conditions would mean a healthy animal herd; a healthy animal herd meant healthy livers; a healthy liver would presage a viable military campaign, or the introduction of a new domestic policy, and so forth. And so the cycles of health and power began to layer upon one and draw from one another: a healthy community meant a more confident imperial mandate, and so forth.

This new linkage would pass through Babylon into the lands of the early Judaic kings. It was here, in the deserts of the virgin holy land, that around 750 BC a new type of human political actor arrived on the scene. These men, wearing thorns and burlap, rained down from the dark mountains of Syria and Jordan and bled into Judea. What they confronted was the political corruption of the kings and pharisees on the one hand, and the physical pestilence of the people on the other. And so they brought with them a new message, a new standard: they are the first to use the condition of the individual body as a measure of the condition of society, and vice-versa.

They called themselves nabi-elohim, God-seers; theirs was an ecstatic and poetic chanting, yelping in the center of the open square, calling the people forever back to Yahweh. The Bible lists their deeds under the title Prophets, and among them we greet Isaiah, Jeremiah and Ezekiel, inventors of the critical language of health and sickness we navigate even today. For 250 years they preached, only to suddenly fall silent, their message having helped forge the earliest Jewish states and destined, as it were, to be cast West, where it reached young and eager Ionian shores.

3 Here the foundations the nabi-elohim laid were elaborated in the Greek mind. If the early Jewish actors had posed questions like “What is health? Why do things get sick?” the early Greek philosophers expanded these premises toward questions like “what is being? Why is there corruption?” And so Anaxagoras and Empedocles, the Miletian Heraclitus, Parmenides of Elea, Pythagoras, Thales and the whole pantheon of presocratic philosopher-mystics turned the critical gaze drawn from the God-seers back upon nature itself. They would seek to know not only the conditions that brought health to man and his social environment, but further the balance between that social environment and the greater economy of nature. To understand the one meant penetrating to the truth of the other. And so it was here that the foundations of natural science would find their first fragile seeds.

But before there was science, the idea of “proof” needed to be invented. Early Greece was a land of superstition, where at any given moment a Cyprus tree could transform into a nymph, the stones could rattle the image of Zeus and the wind could carry the language of Zephyr. As the whole masquerade swarmed around man as though he were in a dream, when afflicted with illness, surely he would have explained this to himself as the handiwork of divinity.

And so the pagan temples and shrines were the make-shift sites of healing; you arrived, made an offering, received a prayer, maybe even an enchanted amulet, and hoped for the best. But in 400 BC, in the space of critical inquiry now opened to the Greek mind, an anonymous tract was written titled “On the Sacred Disease.” It is one of the first attempts ever to record a natural condition, in this case the ravishing scourge of epilepsy, in a language of observation and inquiry.

Where the Prophets had developed the moral language of inquiry, where the natural philosophers had developed the philosophical language of inquiry, it was in fact in medicine that the scientific language of inquiry was born. In short, science began in medicine.

And so Hippocrates of Cos, writing at the end of the 5th century BC, added this tract into compilation with others, providing the west with the first corpus of medical knowledge ever assembled. Hippocrates was also the first to describe cancer as karkinos, likening the dark, hard lumps he felt under the skin of his patients to a crab buried beneath the sand. The historian Herodotus, contemporary of Hippocrates, recounts a story from the same time period. He describes the Persian queen Atossa, wife of Darius, and her experience with what was ostensibly a breast tumor. Atossa initially retreated into herself, refusing royal care, only to be convinced by her closest slave and confident, a Greek named Democedes, to excise the tumor. The surgery, one of the first ever recorded of its kind, was a success. When Atossa asked Democedes what he wanted most in the world, Democedes merely replied: to go home. And so Darius turned his armies, at that point facing East and set to invade Parthia, westward. So came Thermopylae, Platea and Marathon; so came the rise of Sparta and Athens; so came the birth of Western civilization—all because of a tumor.

It was during the height of the Athenian empire in 5th century BC that Plato penned his great utopia: a city ruled by philosophy, where the condition of one’s soul mirrored the condition of one’s community. Aristotle, student of Plato, combined the Platonic doctrine with the momentum of the natural philosophers: and so he rigorously and ruthlessly observed nature, building the first classifying and taxonomic schemes that would form the raw architecture of the biological and material sciences. Aristotle’s utopia would be ruled not just by knowledge, but by scientific knowledge: the good life would be one that was lived amidst one’s peers in the search for truth in this world.

When Aristotle was commissioned by Philip II to instruct Alexander, little did he know that his doctrines, along with the Hippocratic corpus, would follow Alexander’s imperial march

4 deep into Asia Minor and the coasts of northern Africa. In the city of Alexandria, under the rule of Ptolemy, Alexander’s successor, only a single item was categorically listed for confiscation at its bustling ports. It was not wine nor weapon; it was, rather, books. And so it was that every single book that entered Alexandria was taken by the authorities and immediately catalogued in the city’s massive and legendary library; so amassed the knowledge of the ancient world, where Jewish and Muslim scholars such as Avicenna and Averoes would eventually read, copy and preserve the Aristotelian and Hippocratic texts that would have otherwise been lost forever during the dark ages.

But before this juncture, these scholars of the east carried the knowledge of Greece back into the holy land, where the doctrines of holistic care that characterized the Greek model of medicine—fundamentally, a strong body means a strong mind, and vice-versa—would find a radical rebirth in a new language of love. So came Christ. The “social gospel” inaugurated by his advent transformed the law into a matter of the soul, connecting one’s moral “health” not so much with things like reason and a kind-of practical hygiene, but with charity and love. Of the 37 miracles Christ is recorded performing throughout the new testament, 29 involve healing. And so the sickness of this world would not be cured by science or medicine alone: but by and through faith, hope and love.

When an ancient Roman woke up in the morning, he would have confronted a far different world than you and I. I do not mean the obvious facets: different economic, political, social and spiritual systems, different architecture, different language. What I mean is that when he walked out his door he entered a compartmentalized world: above him was the realm of the gods, below him was the realm of Hades, and there he sat upon this hazy, dream-like middleechelon suspended between divine poles. When he died, he would picture his body quite literally travelling upward or downward. Accompanying this was a unique sense of time: he would have felt himself as part of a series of great concentric circles. Just as the seasons passed into one another, so too did empires rise and fall, days wax and wane, men’s lives spark and fade. Pulvis et umbra, dust and shadows, says Horace. Charity was not a concept that rooted well in this mindset: what a man had was directly before him, and while he might eventually find himself dining with the Gods, that was a distant and separate time to come.

So for three centuries the idea of charity lingered at the fringes of the Roman empire, waiting for its invitation in. It was in this time that Claudius Galen appropriated and extended the Hippocratic corpus, ensuring its dissemination across the roman intellectual elite. The invitation for charity, however, arrived with Constantine, who upon his conversion in the early 4th century diverted the massive state coffers of Rome toward new basillicae and churches, new programs of poorhousing and alms-giving. And it was within the next generation that Fabiola founded the first dedicated Western hospital in Rome, inspired as she was by the healing miracles of Christ.

But the shift in the pagan mindset toward charity needed even more: it needed Alaric to use the tool of siege and disease to sack Rome in 410; it needed Augustine to look out his window upon this destruction and divide the world between the city of man and the city of god. And so Augustine collapsed the compartmentalized pagan world into the Christian God: it was not a matter of cycles of time, nor was it a matter of locating oneself, physically, between divine planes: all was god, all was god’s time and god’s space, and all would be judged accordingly. He called this saeculum “Kairos.” And so through Kairos this world was made unreal; we were made its pilgrims; the fruits of our toils would be harvested later, in heaven. Through Kairos, the seeds of charity had grown their own soil.

5 These were our ancient foundations; these were the conditions that inextricably linked science to civilization, civilization to love, love to cure. I will not hold you much longer, for here, for rhetorical purposes, is where our story really revs its engine. You will see what I mean by this. Take some notes—there will be a quiz at the end.

So, what else did our story need? It needed Avicenna to preserve the texts of Galen; it needed those texts to flow back westerward and into the new and burgeoning states of Italy and France; it required the growth of the papacy into the state, and the state into the papacy; it required the norman anonymous to pen his defense of royal authority in 1100, opening the space for the worldly power of the early English kings; it required William of Ockham to suggest that the true ways of god were unknowable—but that our world, and hence our science, were; it required Joachim of Fiore, inspired by Ockham, to declare that the kingdom of god was not someplace else, different, to come—but could be made here, on earth. And so the worldly utopias of the renaissance were born, digging themselves into and carving up the world in the name of God. Our story needed the calamitous 14th century, full of plague and abject death, to give us the disease theory of miasma; it required Martin Luther to pin his 95 Theses on the wooden doors of the Wittenberg Cathedral in 1517—so 30 years later, a young Parisian scholar named Andreas Vesalius, directly inspired by Luther’s iconoclasm, began to open up the bodies of cadavres he would find in the graveyards outside Paris, systematically mapping the various components of the body and producing the West’s first comprehensive anatomy. With that, the received tradition of bodily humors drawn from Hippocrates and Galen, dominant for 2000 years, was forever shattered.

Our story required Francis Bacon to here about Vesalius’ and declare in 1580 that science was power, redirecting the trajectory of scientific inquiry away from abstract philosophical explanation and toward experimentation—a radical probing and testing of nature. Science, he declared, would be the route to our salvation. This doctrine in turn inspired Descartes, who expanded it into a mechanistic philosophy of the natural world; in this mindset, Robert Boyle introduced the laws of gas pressure and volume in 1660, which, by the end of the century, would greatly inform Isaac Newton’s creation of the calculus; Newton would impact Priestly, who in 1774 discovered the properties of oxygen; Priestly would inspire Thomas Beddoes and Humphry Davy, who developed Nitrous Oxide in 1795. This was the basis for James Simspon to synthesize chloroform in the early 19th century, such that by 1853 John Snow could administer the drug to Queen Victoria during the birth of Leopold. The Queen liked the agent so much that it became part of the standard surgical procedure for the royal medical corpus. And so the era of anastethsia was solidified—the exploration into the human body, its surgical cure, made possible as never before.

Our story required Immanuel Kant to overturn the notion of Kairos, substituting in its place the secular religion of progress, where time was seen as a linear march toward some ultimate end, giving science and medicine a new, definitive sense of historical direction. Within the conceptual framework of this progressive worldview, the Scottish surgeon John Hunter developed the science of tumor staging in the 1760s; tweaks to the science behind this methodology led directly to Edward Jenner’s smallpox vaccine in 1796. For the first time in human history, mankind had developed a way to vanquish its ancient foe—and so, in turn, did von Behring and Kitasato develop the vaccines that would decimate tetanus and diphtheria; so too would Alexander Fleming stumble upon penicillin in 1928, only for the drug to be synthesized by Howard Florey and Ernst Chain under the looming shadow of total war in 1940—

6 the same era that saw the creation of both the National Institutes of Health and the National Cancer Institute under FDR. So too, under the leadership of the NIH, would polio fall to Albert Sabin in 1957—measles six years later.

Our story required Thodore Schwann and Rudolf Virchow to argue for the cellular theory of life, displacing the miasmic doctrine of disease with the basis of modern germ theory. And so it was that during the American Apocalypse, in 1865, that Joseph Lister, working under the burgeoning idea of germs, introduced the first surgical disinfectant, Phenol. This inspired Louis Pasteur to investigate the biological nature of cells; Pasteur’s work helped to ensure that the new cloth mill industries that were booming in England would remain sites of public health. It was within these mills that the first synthetic dyes were synthesized. It was with one of these dyes, Trypan Red, a bold, beautiful vermillion, that interested a young chemist named Paul Ehrlich.

Ehrlich studied the dye and isolated its key chemical component; when he added this component to a simple chain of hydrocarbons, he found that it had particular cytotoxic properties. Ehrlich called the drug Savarsin. When he was awarded the Nobel prize in 1908 for his discovery, there was no name to call it by. We now refer to it as chemotherapy. And it was with this discovery, some 4533 years since Imhotep’s first haunting declaration, that a chink had finally been found in the armor of the emperor.

Our story required Hopkins to open in 1889, its medical school to follow 4 years later, where William Halsted, taking advantage of the new era of anesthesia, would develop the radical cancer surgery. A subset of this surgery would be advanced by Alan Whipple, who in 1935 completed the first modern pancreaduodectomy. Our story required Wilhelm Rontgen, operating within the Newtonian framework, to develop the theory of x-rays in 1895; within a year, Becquerel discovered radiation and Grubbe saw its implications for cancer. This made possible not only the intensive radiation therapy that would become a staple part of our medical armaments, but also the CAT scan technologies that were developed in 1972. Oh, and Dr. Wolfgang, I know we have an appointment scheduled for this upcoming Tuesday, but to keep matters short and sweet: my scan last week came back; no mets; improved tumor status; all looks good. So I’d really love to meet your scalpel one last time, give it my thanks, and finally be rid of this goddamn disease.

Finally, our story required men and women like Sidney Farber and Mary Lasker— evangelists for the anti-cancer cause, who took cancer out of the attic shadows and thrust it into the public light. They developed the public relations technologies that made possible our capacity to speak about the disease today so openly and without shame. It was under their brilliant pressure that Nixon signed the national cancer act in 1971—the first time in world history a major state government had made it part of its explicit program to end a disease. From that point forward, you pretty much know the rest—however, might I mention one last moment, in 2010, when a chemotherapy cocktail that consisted in the drugs lukavorin, ironotican, oxaliplatin and flouraouracil 5-FU was approved by the FDA. This drug is hell on earth; this drug is poison to the soul; this drug darkness, pure and simple. This drug saved my life. See this from my perspective: for 10,000 years mankind has lingered in ignorance, mankind has toiled to understand and to know. For 10,000 years a human being, if and when afflicted with cancer, would certainly and categorically die from the disease. I was diagnosed in 2016. 6 years separated me from that abyss. How does one come to explain this to themselves?

As I stand here and you sit there, I yearn so badly to close that human distance, to say as directly and humbly as I can to you: “Do you see it? Do you see what I have seen? Do you see, below the mask, behind the veil, across these dying generations—do you see something smiling

7 through it all?” And here is the core of my modest proposal: that nights like this evening, projects like Dr. Wolfgang’s and Dr. Pishvaian’s and Dr. Javed’s, efforts like that of my mother and father, are not arbitrary attempts at our own selfish survival—no, they fulfill the deepest intentions of God. And so the gravity of this disease takes on its true form: “Unlock me,” cancer beckons, “and you will unlock it all.”

This is how a young cancer patient, along with an unbelievable network of love and generosity and unconditional support, comes to survive this disease for three years. This is how this world makes sense to me now, how it hangs together: I look back upon what our story has accomplished and I see the great arc of history bending toward the resolution of a conflict. I see this conflict as death—it’s resolution, life.

Immortality was once described to me as a kind of choice. It was likened to that moment —and I believe everyone here was born before the ipad era, so this should be familiar—it was likened to that moment as a child where, during the dogdays of a summer afternoon, playing against the setting sun, the oak and vetch and forests of youth, you are called back inside for dinner. The promise of immortality, like the promise of chemotherapy, says simply and softly: “I am not ready yet; just a little more time.” And so you will eventually return home; you will cross the threshold; you will lie yourself to rest amongst the love of family—for all things ultimately perish. But you may leave the playfields of your days at your own pace; you may linger past the sunset; you may even stay up past your bedtime. Immortality does not say, boldly and hubristically: “I will never die!” It rather whispers, with a still-small voice, “Just a little longer.”

Alfred North Whitehead, the great logician and philosopher of the 20th century, once claimed that the crowning achievement of Western metaphysics lay in a single two-line quote.

He found this quote not in Plato, nor Descartes, nor Kant nor Russell; rather, he found it in a little-known hymn by the 19th century organist, Henry Lyte. The refrain of the hymn took a simple, humble, unassuming tone: “Abide with me,” Lyte began, “Fast falls the eventide.” And here it was for Whitehead: the flux, the chaos, the dynamic ebb and flow, the wax and wane, the cycles of life and death and rebirth, the indecipherable augers and abandoned chapels of history, the great simmering project called “mankind.” All of this matched by that most human desire just for a little bit of company, to find some stability amidst the perpetual perishing, to live past our own time and into that of another. And so we are here tonight, friends and family, supporters and coconspirators, committed to a new world, a world very much within our reach, a world in which we can say: “Come, abide with me; the eventide will not fall just yet.”

Thank you all so very, very much.