Letter From the Editor

Bruce D. Cheson, MD

Clinical Advances in Hematology & Oncology

June 2013, Volume 11, Issue 6


“Atheists Don’t Have No Songs”

—Title of a song by Steve Martin from Rare Bird Alert

I work at a Jesuit university. Thus, it was not without a touch of irony that I chose Mortality by Christopher Hitchens for the most recent Book Club for our fellows, nurses, and faculty. The nibbles were the usual, the wines included a pleasant Frascati and a decent Malbec. I thought I might disarm the room with my initial inquiry as to whether, after reading the book, any of them had considered becoming atheists. To the person, they vehemently denied even entertaining the possibility. To put the question and responses into context: Hitchens was a great British-American author, essayist, and journalist; but, more importantly for this discussion, he was a devout antitheist. The book is his story of his “year of living dyingly” with and from esophageal cancer, told from his unique perspective of his failed battle with the disease (he loved the struggle analogy). Of relevance to our group was that he spent part of his inpatient time in our hospital, a place he remembered as having a big black cross on the wall opposite the patient bed.

Without directly arguing against religion, he presents many examples of hypocrisy by those who are religious pretenders; those who claim that his cancer was God’s revenge against his blasphemy, enacted by selecting one of his most blasphemous organs to subject him to the pain and suffering he so deserved. There are those who claim to be nothing in the eyes of their deity, but who feel that he (He, She?) needs to pay direct and prompt attention to their individual plight. To them, Hitchens responds with a quote from one of my favorites, Ambrose Bierce, who, in his Devil’s Dictionary (which sits front and center on my desk), defined prayer as, “A petition that the laws of nature be suspended in favor of the petitioner, himself confessedly unworthy.” The book engendered thoughtful discussion about how patients view themselves differently from how the world sees them. They are in a new club, with its own rules and vocabulary. Whereas Groucho said he would refuse to join any club that would have him as a member, Hitchens, unfortunately, had no such choice. Hitchens recreates conversations between outsiders to his new world and those within, where empathy and sympathy collide, and tact too often falls by the wayside. When visited by someone who says, “What doesn’t kill you makes you stronger,” he notes the many things that don’t kill you but make you a whole lot weaker. As a solution, he recommends a course for both sufferers and outsiders such that encounters are less uncomfortable and painful, but more enlightening and comforting.

He describes how, over time, even the mundane, such as phlebotomy, descended from an almost pleasurable social event to a dreaded occasion. Yet his description is not with self-pity, but with sympathy for the technicians who did not enjoy what they were subjecting him to as it became progressively more difficult to extract the necessary sample. His narrative included a compelling and graphic description of the impact of the disease and its treatment-associated weight loss, peripheral neuropathy, and loss of libido. But what distressed him the most was the loss of his most vital organ, his voice. It was a voice that had brought him international acclaim as a speaker and debater, but which was now silenced. Rather than making the Jobsian error of seeking alternative approaches when there were others with the potential for a measure of therapeutic success, Hitchens sought for a scientific approach, exploring a novel genetic study at the NCI but finding, to his dismay, that his tumor lacked an essential protein. He even offered his tumor tissue to Francis Collins for DNA sequencing. Hitchens never asked “Why me?” because he knew his own answer would be “Why not?” Instead, he described the “blues” he experienced with a sense of disappointment that he had not accomplished all he might have and quoted Horace Mann: “Until you have done something for humanity, you should be ashamed to die.”

Hitchens was a man who clearly did not need religion, except as a target for debate. As a line goes in the Steve Martin song noted above referring to atheists: “In their song they have a rule, the ‘he’ is always lower case.” It was apparent, however, that his life was still full and rewarding, rich with humor, talent, intellect, and, most importantly, the love of friends and family. When asked whom I might want to sit down next to at dinner, my perennial response is Jon Stewart. However, after reading this book, I wish on the other side of me could have been Christopher Hitchens. His life, as well as the book, ended far too soon.

Until next month . . .

Bruce D. Cheson, MD