In the Elector’s School

There is nothing remarkable about being a cancer patient: more North Americans get this diagnosis than a college education. I’m sixty-nine-years old and have lost many friends and acquaintances to cancer; I had a day recently when I learned of two such deaths.

…and following came Such a long train of spirits, I should never Have thought, that death had undone so many. (Dante, Inferno, Canto 3) e City of Cancer is the liminal space between the Republic of the Healthy and the Kingdom of Death. It has a gate on which it is carved, “ rough me, you pass into the city of woe” (Canto 3, line 1). at gate is the diagnosis.

On July 2nd, 2020, I started coughing blood. I’d been having throat pain and di culty swallowing for months. I am a psychologist and a medical school professor in Ottawa, Ontario; my wife is a psychiatrist and professor. We knew what these symptoms could mean. But I could not get a diagnostic assessment because the pandemic blocked face-to-face medical appointments. I called my family physician and described the blood when I coughed. He sent me to the Emergency Department.

I arrived at 3:00 PM, and it was standing room only. At 8:00 PM, I was examined by a young doctor in training to become an emergency physician. He looked in my throat, said medical words that translated to “Uh oh,” and ordered a CT scan. I was scanned a few hours later and sat in the waiting room until 3:00 AM on July 3. I was called to an exam room, and a senior doctor came in. She said directly but quietly, gently, and gracefully, “I have serious news.” I was coughing blood because a tumor had broken through the tissue lining the inside of my throat.

Getting the diagnosis was the beginning of a di cult journey. In the Journal of the American Medical Association, Samuel Auger wrote: e emotional and physical stress on patients with head and neck cancer through diagnosis, treatment, and surveillance can be immense, and greater than that experienced by other cancer survivors. Rates of suicidality are twice that of other patients with cancer, triple that of the general US population, and increasing.

I am a Christian, but I have always been reluctant to pray for myself, believing that I have received more than I needed or deserved. When I got the serious news, praying did not occur to me.

Modern medicine, when done well, engages patients in making decisions about their care. Meeting with several cancer specialists, my wife and I threw ourselves at the question of what should be done. My tumor was far back in my throat, at the base of my tongue. at location meant surgery was not the rst treatment option because it could kill my tongue. Instead, the standard treatment is to burn the tumor with focused radiation and poison it with one or more potent but highly toxic chemotherapeutic drugs. is combination has an 80% 5-year survival rate for cancer like mine. Let’s be clear, though: chemotherapy works by killing cancer cells faster than it kills you. Among the many side e ects, there’s a risk of “chemo brain”—signi cant and persistent cognitive impairment. I agreed to the radiation but declined chemotherapy, which dropped my survival chances to 75%. My decision surprised my doctors.

Why accept an additional 1 in 20 chances of dying?

My wife describes me as “relentlessly mission-driven.” at mission is to improve child and adolescent mental health and, to that end, to understand why the healthcare system so often fails to help kids in trouble. I wasn’t always this way. I graduated from college in 1976, blinded by depression and writer’s block. e university gave us our degrees and opened the gate to the world, and I tumbled out face- rst. I didn’t just lack direction; I lacked the sense that life had directions. ere wasn’t a moment when that blind young man found direction; there were many. I took a minimum-wage job as a childcare worker for institutionalized mentally ill children. I woke from a nap in my girlfriend’s apartment and found John’s Gospel on her bookshelf. I read the rst chapter and the light did not dawn, but the horizon warmed just a bit. After several years of rank-and- le mental health work, I saw that the Freudian doctors at the hospital were guided by theories, not evidence, and that the kids weren’t getting better. I left therapeutic childcare and went to graduate school to nd methods for caring for sick children that worked.

Fast forward to the mid-90s, when I was a professor. It was 2:00 AM in my o ce in a vast American hospital. ere was a blizzard. I was writing a research proposal due the next day to the National Institute of Mental Health, and I set out to look for co ee.

I crossed an aerial bridge connecting two buildings, three stories above the street, a quiet glass tunnel of warmth and light. Ahead of me, orderlies pushed a gurney, transporting an apparently comatose girl to some urgent procedure. Her parents trailed them, en- during what looked like the worst night of their lives. I had young children, and the scene terri ed me. However, the parents’ grief also testied to how much children’s healthcare can matter. Why, in 2020, did I decline chemo? One reason was that I feared I might be cured but lose the mental acuity to do scienti c work in the cause of children’s health. at’s the attering way to frame my decision. Calvin said that “man’s nature … is a perpetual factory of idols” ( Institutes 1.11.8). Scienti c careers o er many false gods, starting with the worship of (what you imagine to be) your own ability. Tenacity in the pursuit of excellence is likewise a false god. is is true even if you pursue excellence to win your own approval rather than for the acclaim of a crowd. e point is to seek the truth. A career of climbing steep learning curves red me in a kiln, transforming me from a depressed adolescent into a focused adult. But struggling with di culty became an addiction. Marriage and children tempered this; love partially displaced struggle at the molten core of life. Nevertheless, I declined chemo to safeguard my abilities, so I could continue the struggle. Getting better at hard things was my only way to live.

Radiation was a hard path. Five days a week, for seven weeks, I lay with my head inside a large machine that targeted high-energy radiation at my tumor. My head was held still by a rigid mask covering my head, neck, and face. I had to master the fear this induced. My head needed to be still so that high-energy beams could be precisely aimed to intersect at the tumor and burn it out. Unfortunately, these beams must pass through my neck to reach the tumor, damaging the surrounding esh. e radiation killed most of my saliva glands and taste buds. I couldn’t taste anything, but that didn’t matter because my throat was blistered, and I couldn’t swallow anything. A tube was inserted through my nose and down my throat past the tumor site, and I learned to feed myself by dangling bags of liquid nutrition from an IV pole. Between cancer and the treatment, I lost 40 pounds. en it was over, and in a few months my ability to eat and taste mostly returned. e initial scans suggested that we might have killed the tumor.

Until they didn’t. e throat pain came back. Worrisome CT scans were con rmed by a dire result from a biopsy. Resilient and militant, my tumor was on the march, and we needed a new treatment option. e cancer center scheduled a meeting with the surgeon who had con rmed my initial diagnosis.