BROKEN PORTIONS

Richard was thirty-three years old when he was diagnosed with stage IVB Hodgkin’s disease. This, in 1973, was a death sentence. A large tumor in his chest was growing rapidly; the cancer had already spread to his spleen, liver, and bones. Two vertebrae had disintegrated from the malignancy in his spine. There was nothing to be done, Richard said, except to read carefully through his life-insurance policies, write up the experiments he had been working on, and think of a way to say goodbye to his three-year-old daughter and his twin sons, born only months earlier.

Richard’s colleagues insisted he fly out to the West Coast for a consultation with Henry Kaplan, the Stanford oncologist who had pioneered a radically aggressive treatment for Hodgkin’s disease. Over the next two years, Richard received massive doses of radiation and chemotherapy, which saved his life. He attributed this stay of death to the fearlessness and the restless brilliance of his physician. Kaplan’s “secular miracle,” as Richard put it, lost no wonder for him because it came from a doctor rather than an ancient faith or prayers. On the contrary, it intensified his childhood belief that science could do incomprehensible things.

Richard caught the morning side of a fast-breaking wave in medical science, and he remained indebted to clinical scientists, especially Henry Kaplan, for the rest of his life. He regarded the nearly thirty years of life he had after his diagnosis of Hodgkin’s disease as a gift neither deserved nor undeserved, but an astonishing feat of medicine. He did not believe that the seeds of death left in him by the radiation were unjust. He knew what he owed to science, and he had an unassailable gratitude toward his doctors. Nothing changed those basic beliefs.

Richard stayed well for twenty years. The second ten of these were ours, a decade of health that lulled us into believing that his past medical problems were truly past, not the determinant of our future. The next decade, however, defined more by illness than by health, established that the arrangement between his life and his death was a darker one. Kaplan’s treatment for Hodgkin’s disease had been brilliant but imperfect, as science at its frontiers so often is. Radiation, which cured Richard of his first cancer, was to come back three times: twice nearly to kill him and the third time to succeed.

We knew such delayed damage was possible. Leukemias and other late-occurring cancers were not uncommon in patients treated with radiation; more recently, doctors had observed that a disturbing number of the Hodgkin’s patients who had been treated with high-dose radiation were also dying of “silent” heart disease. Because Richard had been a part of the early Stanford clinical trials, our internist ordered a cardiac stress test; it had to be stopped. The year before we got married, Richard was treated at Johns Hopkins for a 99.9 percent blockage in his left anterior descending artery, a vessel subtly referred to by cardiologists as the “widow maker.” Four hospitalizations later, Richard’s heart was again hale and fit and, for a handful of years, he had an easy health. We were more wary than we had been before but thought, without thinking well, that we had paid our dues for his earlier survival of Hodgkin’s.

It was never to be that easy. In the summer of 1999, fast and without warning, Richard got very sick. His weight plummeted and he found it hard to breathe. He no longer was the alert, intensely curious man I had fallen in love with; rather, he was dull and disinterested. I scarcely recognized him. Richard was fading away quickly, melting like the Wicked Witch, someone for whom, when he was well, Richard maintained a strong affection.

The scans ordered by our internist revealed tumors in Richard’s liver, rectal wall, and lungs. No one tried to minimize this medical reality, although, in an unthinking moment of whistling past the graveyard, I mumbled something about the advances being made by our colleagues in oncology. This seemed improbable even as I said it. Richard looked at me incredulously: there was little hope against tumors strewn archipelago-like, so far and wide throughout his body. Richard and I were optimists by nature, but not insensate.

Neither of us slept that night, reaching out for each other, troubled and restless: talking, silent; lights on, lights off; looking through Richard’s old medical textbooks—hopelessly out of date in their discussions of cancer—to find a phrase or a statistic that might dampen the horror for a while. We went through every “What if?” we could imagine—and we could imagine many—and then drew into our collective self, coiled around each other in some ancient mammalian way to fend off desperation.

The next day was better, in part because it was the day and not the night, and in part because it was not possible for it to be worse. Richard’s preliminary biopsy results offered us some hope, as well; it was possible that Richard had lymphoma, not metastatic solid tumor disease. Lymphoma, in our new world of bad options, was a good thing; it carried the possibility of life. My Hopkins colleagues made an appointment for us to see an oncologist at Hopkins the next day. I will go to my death, as Richard did his, more than willing to walk on broken glass for him.

Richard Ambinder, the director of hematologic malignancies at Hopkins, took one look at Richard and said, “So. You look sick.” This, in itself, would not have been enough to secure our trust; it was not a penetrating observation. The lucidity and rigor with which he laid out the diagnostic and treatment possibilities, however, and the insistent concern with which he regarded Richard’s rapidly deteriorating condition, did catch our attention. Richard’s MRI scans showed clearly malignant disease, he said, and it was progressing rapidly. If Richard did not get immediate and aggressive treatment, he would die. We had entered the blunt and exquisitely competent world of Ambinder and were relieved to have done so.

Ambinder said he would consult a Hopkins pathologist and one of his colleagues at the National Institutes of Health (NIH); if it turned out to be a solid tumor malignancy, he did not hold out much hope. If it was Burkitt’s lymphoma, as he thought likely, Richard had a chance. Ambinder grasped Richard’s shoulder and told him that he and the Hopkins staff would take good care of him. He then turned to me and assured me of the same. He took Richard up to the ward himself, talking with him all the while about their research interests and common experiences as medical students at Hopkins. I saw, for the first time in weeks, a trace of animation in Richard’s eyes. I also saw him tap deeply into the trinitarian roots of his true faith: Medicine, Science, and Hopkins.

Ambinder told us that the pathologist would talk to me later that evening about his diagnostic impressions and suggestions for treatment. Things would get moving; everyone would do what could be done. No grass grew under Ambinder’s feet.

The pathologist called that night. Richard almost certainly had Burkitt’s lymphoma, he said, and he concurred with Ambinder that if Richard did not start chemotherapy straightaway he would die. His directness, together with his careful description of Richard’s disease and its prognosis, made our decision relatively easy. He and Ambinder did not present an array of complex and competing options. There were no meaningful options besides chemotherapy, and there was no point in wasting time.

Ambinder had said that if Richard responded to the chemotherapy, he was likely to show a quick and dramatic improvement in his symptoms. This was true. I went to sleep in a chair next to Richard’s bed that night and woke up in the morning to find him smiling at me, revived as from the dead. Not among the quick, perhaps, but a bracing distance from the dead. “I think I like this doctor,” he said. “I think I like him very much.”

A few weeks after Richard’s dramatic response to chemotherapy, Ambinder recommended that he undergo a peripheral stem cell transplant. Stem cells would be recruited from his bone marrow into his bloodstream, removed, and stored. In order to destroy any remaining cancer cells, he would undergo eight days of very high-dose chemotherapy His previously harvested stem cells would then be transplanted into him through his veins and stimulated to proliferate. In painstaking detail, Am-binder made it clear to us that Richard was a high-risk patient undergoing a high-risk procedure. Death was a distinct possibility. Death was becoming part of what we had to think about.

Richard was sick for a long time. He lost his hair, retched and vomited in places too many to mention, and became transiently psychotic from steroids. One day, as he put it, he shed his gut like a snake sheds its skin. Anticancer drugs were injected directly into his cerebrospinal fluid. He endured so many uncomfortable and harrowing procedures that what he went through was only partially imaginable to me. Yet he remained imperturbable and wryly engaged with life; he gave patience a good name.

Richard received a bone marrow transplant in early December of 1999, and then we did what cancer requires one to do: we waited. We waited for the results of blood tests and scans; we waited for the inevitable complications; and, most rackingly, we waited to see if his transplant would produce the cells he needed to stay alive. A normal white cell count is between four thousand and eleven thousand; at one point, Richard’s was thirty. He was more tense during this time than I had ever seen him, keenly aware of the danger if his transplant failed.

Richard did what I had always known him to do when he was hurt or worried: he turned inward, to his imagination. One day, for diversion, he called up the names of all of the rivers he knew; on other days, it was stars and constellations, or viruses and bacteria. One night, during a particularly difficult time, he reconstructed in his mind, bone by bone, the skeleton of a dinosaur in Chicago’s Field Museum, which he had visited as a child. As his physical health improved, his mind regained its elegant inventiveness. I came into his room one morning to find that he had spent much of the night conjuring up a brain nearly as large as his hospital room and had then set about exploring it. He hiked across its fissures and rappelled his way down the substantia nigra, a part of the brain he had studied and particularly liked. He swam in the brain’s ventricles and bounced up and down on the optic nerve. Richard was on his way back.

Mostly he slept and I did needlepoint, or I read to him from Sherlock Holmes or from Antoine de Saint-Exupéry’s Wind, Sand and Stars. When he was better, I read to him from Annie Dillard’s Pilgrim at Tinker Creek, a book he had given to me shortly after we met. We talked at length about the naturalists and the scientists I was studying for a book I was writing about exuberance. He fell in love, as I had, with Wilson “Snowflake” Bentley and Bentley’s world of snowflakes, and many times I came into his hospital room to find him asleep with Bentley’s book of snow crystal photographs open on his chest, or lying next to him on his bed.

Richard was discharged from the hospital on the winter solstice, profoundly weak and glad to see something other than hospital walls. We spent Christmas and its surrounding days in a Baltimore hotel near Hopkins so that he could receive intensive outpatient care. It was a difficult time—he was frail and his immune system more so—but we soon fell into a quiet rhythm that was not without its appeal. Each morning, we went together to the oncology clinic, where he had his blood drawn, and then we waited to hear the day’s numbers, each of which took on its own significance and created its own anxieties when it was too high or too low. We talked to other cancer patients, which we loved doing and which gave us heart. In the afternoons, we went back to our room and listened to carols, or Richard slept and I read. We lay nestled together at night, taking joy in the season and in the warmth of our bodies next to each other.

Richard got better. He gained back his weight and we gained back our hopes. We worried less about each fleeting fever or day of fatigue and, after a long time’s passing, we made love again. Slowly, gently, we fell back into life. One day several months after Richard’s transplant, we went to Hopkins for a routine follow-up visit and waited for Ambinder to give us the results of Richard’s most recent lab tests and scans. We had cause to be optimistic, but dread tends to trump optimism when one is waiting for results in an oncologist’s office.

Ambinder lumbered into the room, radiant. This was a good sign; Ambinder is not an essentially radiant man. “So,” he said to Richard, “I think you are well. I think you have beaten this thing.” Richard and I, used to Ambinder’s more usual bluntness and nuanced pessimism, sat silent and disbelieving. Then it sunk in.

Those minutes of pure joy will stay with me always: Richard smiling at me, me at him, both of us at Ambinder, and Ambinder at Richard and me. It had been a terrible, intimate journey with the best doctor we could have asked for. Ambinder had taken Richard through a grave illness and high-risk medical procedures. He had been blunt, clinically astute, and kind. He had not promised what he could not deliver. He had been everything one could wish for in a physician, and I felt toward him the kind of gratitude and respect you feel for someone who has saved the life of the person you most need and love. Richard, in turn, felt for him the kind of respect that, until that point, he had given only to Henry Kaplan at Stanford. Ambinder, he said, was a “doctor’s doctor and a scientist’s scientist.” That was as good as it got for Richard.

We owed a great debt to the rest of the medical and nursing staff at Hopkins as well, and in a more abstract way, to Hopkins itself, a great teaching hospital. Richard was convinced that who he was as a physician, and much of how he did his science, came directly from his medical education at Hopkins. For my part, I had fallen in love with Hopkins the first day I joined the faculty and had stayed in love ever since. Our Hopkins bond was a strong one. Sometimes, after one or the other of us would return from giving a lecture or doing Grand Rounds at another hospital, we would compare our experiences there to those at Hopkins. Fairly or not, there was never any serious competition. We might acknowledge that another medical school did good science or had good doctors, but Richard would usually end up saying, with a trace of the romance that Hopkins often evokes, “I don’t know. There’s just something about Hopkins.” It was a phrase we used many times as shorthand for how we felt: no long discussions, no elaborate comparisons. One of us would turn to the other and say, “I don’t know. There’s just something about Hopkins.”

After our meeting with Ambinder, we decided we should do something to mark the moment. A believer might have suggested we stop at the hospital chapel, but Richard, who was Jewish, was not a believer. Instead, he said quietly, “Let’s go to Hurd Hall.” We sat together in the hospital’s great clinical teaching amphitheater, where he and I had taught and been taught, and found ourselves absorbed in thought, each trying to comprehend what we had just been told. Neither of us said anything. There was just peace. Just quiet. Finally, Richard put his arm around me, looked around the amphitheater again, and said, “I love this place.” Then we went home.

In the months to follow, we had our future back. Richard threw himself into his science, we saw our friends often, and we arranged to give lectures without being concerned that we would have to cancel them. Richard worked on his studies of schizophrenia and started seeing patients again. I, with delight, got back to writing my book about exuberance; we began to make up for time lost and commitments broken. It was a magical interlude, gentle and love-filled, perfused with thankfulness. It might have lasted, but it didn’t.

Six months after our celebratory meeting with Am-binder, Richard returned to Hopkins for a follow-up visit. Richard’s most recent scans did not look good, said Ambinder. There was a mass in his lung, and it looked like cancer. The thoracic surgeon Ambinder had consulted did not think it was cancer, but neither of us found this reassuring. Unfortunately, we trusted Ambinder’s clinical intuition. We would have to wait for more consults and the results of a lung biopsy.

We snapped back into the dark space we had occupied before with the Burkitt’s, but tried to get on with our lives until we knew for certain whether Richard had lung cancer. We saw friends, we worked, we loved. But there was fear again, and dread. Uncertainty was in everything we did. For each time we did something of consequence, there was a moment of ice-cold fear, a question unasked: Is this the last time we will do this? How long do we have? How will he die? When? Where?

There was a possibility that Ambinder was wrong—anything was possible—and this slim chance allowed us to make it through for a while. The last days of November slid into December, a time of year we both loved, and a time in Washington we particularly loved. We lived what we knew to live. My mother and I bought a Christmas tree and a juniper wreath and we strung the lights. We listened to carols and watched, as we did every year, The Bishop’s Wife. We waited, with the rest of America, for the outcome of Bush v. Gore in the United States Supreme Court. We waited for the results of Richard’s lung biopsy, which, when we got them in mid-December, were unequivocal. Richard had lung cancer, it had spread to both lungs, and it was inoperable.

Our initial reaction was paralysis, then shock. These feelings protected us for an hour or so, and then everything became a nightmare. I poured us each a scotch and we crawled into bed to talk and to hold each other. We were not by temperament inclined to view difficulties in our lives as unfair—we never questioned that we had been immensely lucky in friends and opportunities and in having each other—but this day was an exception. It was the first and the last time we ever said it, but it did seem unfair. We had just gotten back to our normal lives, or thought we had, after months of chemotherapy, a bone marrow transplant, and long months of terrible anxiety. We had spent our store of emotional energy on fighting his lymphoma and, once we knew he was cured, had put the experience behind us as well and as fast as we could. We had grown accustomed to having an open future again and to knowing our days as less worried, lighter and easier. We were beginning to take for granted making love again, and laughing without constraint. We had shed the greater part of our morbid irony.

It was a long night. I slept little and badly, constantly reaching out for Richard, burrowing my head in his shoulder, listening to him breathe. Richard, more practical than I, took a prodigious amount of diazepam and slept soundly. The next morning, we talked about what to do to make the best of things. Neither of us knew how long he would live—the life expectancy for his kind of lung cancer was six months—but we had always enjoyed each other’s company, and we were determined not to allow the prospect of death to take that from us. Indeed, as we desperately sought some hint of a silver lining, we realized we would have more time in each other’s company than we had ever had. This would be a good thing.

Somehow the morning and the afternoon passed; they must have. I built a fire in the fireplace, put on Christmas carols, and told Richard that I had planned a romantic evening—music, wine, and dinner in front of the fire—and that no matter what happened, I was, as always, his for the asking.

Richard began to cough, a deep and frightening cough. I panicked and immediately assumed the worst: we were going to have even less time than we had imagined. With a bitterness I did not know I had, I thought: Enough—God never opens a window that he doesn’t close another two. My bitterness was premature. Richard pointed frantically at the fireplace, which was filling fast with smoke. Soon, the living room and finally the entire house were full of smoke. We were living an Addams Family nightmare. Squirrels, it seemed, had built a nest in our chimney, and while they broiled, we smoked.

Hacking, Richard and I made our way up to the top floor of the house, abandoning carols and romance as we went. I was disconsolate at what I had done, desperate that my plans for an evening of love had so ridiculously gone up in smoke. I couldn’t even get the first evening right; what would happen in the months ahead?

Richard, seeing how I felt, put his arms around me.

“Thank you for the fire,” he said.

He paused slightly.

“Did you know that smoke is a carcinogen?” he asked.

There was a moment of horrible silence. Then I saw the smile on his face, and we both burst out laughing. We were on our way to dealing with something unknown and awful but at least we were going to be in it together. And, we would have Richard’s wit to help.

Richard’s prognosis focused our thinking. I canceled as many of my lectures and academic commitments as I could in order to stay at home and look after him. We canceled professional trips to Davos and London and Rome, but kept our plans to visit Los Angeles in a few weeks’ time. We had close friends and family there and could read and relax. We could walk alongside the ocean. Richard was still alive, and we did not plan beyond that.

Certainly, the Christmas season was sad, but it was at times quite wonderful as well; we laughed even more often than we usually did, and reached out to each other with more need and a tender pleasure. It was Christmas made lovelier for our thinking it was our last. Life, strangely and redeemingly, went on in a rather normal way. Knowing that death was likely within the year, we laughed and loved and took little for granted.

A week or so before Christmas, we had dinner in Georgetown with close friends of ours, Bob and Mary Jane Gallo, both of whom had been unimaginably kind to us during the long months of Richard’s chemotherapy and bone marrow transplant. Bob, a virologist and an AIDS researcher, was talking science with Richard when he stopped suddenly, looked directly at Richard, and said, “It’s great. I can’t believe how much better you look.” My heart dropped fast and froze. It was only two days after the Hopkins pathologist had confirmed the diagnosis of lung cancer, and we were still trying to figure out how to tell our friends and colleagues.

Richard told them about the diagnosis. Bob looked stricken and was, for a while, uncharacteristically quiet. He and Richard were particularly close. Bob had been the head of a major laboratory at the National Cancer Institute (NCI), part of the National Institutes of Health in Bethesda, for decades; both were doctors. No one needed to say aloud what it meant to be diagnosed with inoperable lung cancer, particularly in the wake of a recent bone marrow transplant. I could see Bob taking it all in, and I could see Richard watching Bob taking it all in.

Bob shifted out of silence. He asked Richard to fax him the biopsy results as soon as we got home and to have the pathologist send him any viable cells obtained during the biopsy. He would consult with other scientists and oncologists to find out which experimental protocols might help. His own laboratory had recently synthesized a naturally occurring compound that promoted a form of cell death. He thought it might be possible to use this against proliferating cancer cells. To this end, he proposed growing cells from Richard’s lungs in mice genetically engineered to have no immune system. (These mice were later christened “Little Richards,” and, for a while, the tumors thrived as they should and died as they should. And then they didn’t.) Bob said he would read up on Richard’s particular type of lung cancer, talk with experimental vaccine and gene therapy specialists, and place calls to colleagues at the National Cancer Institute, Dana-Farber at Harvard, M. D. Anderson, and Sloan-Kettering. He would immediately consult with Richard’s oncologist at Hopkins.

By evening’s end, friendship, wine, and the possibility—the unlikely possibility—that science might outgambit Richard’s cancer gave us enough hope to confront the immediate future. Our friends heartened us; our belief in science kept us from abject despair. It was the beginning of a quest that was to be marked by a thousand acts of kindness and capability from friends, colleagues, and strangers. It was a journey to save Richard, and it took place during an unnerving era in medical science. It was a time when, as now, hope could reasonably exist next to a prognosis of death; a time when the odds of staying alive or dying were whirling, inconstant things; a time when science could suggest, but not guarantee, breathtaking results.

Our difficulty would be to navigate between false and reasonable hope, and to avail ourselves of new knowledge that might save Richard’s life while, at the same time, keeping close to our hearts the inescapable truth that Richard was likely to die. The truth would be what it would be; it would be what we would have to come to terms with, and it would demand our first commitment. We did not want to send ourselves on a fool’s errand, flying after every new and as yet unproven treatment, but neither did we want to give up and cease to explore possibilities that might save or prolong his life.

When I look back on those darkly wonderful days of Christmas, I remember the gentleness and love we had for each other, and I can feel still the warmth we took in from friends and colleagues who reached out to us with such generosity. Dread would hit unawares at times, paralyzing us for a moment or an hour. But we found the dread to be as often as not reversible; love and friends, and our awareness of the shortness of the time that we had, worked well enough, often enough, to keep us from drowning. Richard ran his lab meetings from our living room and worked, as ever, into the early morning hours. I burned Christmas cookies, and broke my heart trimming our tree with ornaments we had gathered over the years. I hung the snowflakes made of gingerbread and the glass candy canes on the tree branches, and then added an ugly clay parrot we had gotten at a scientific meeting in Puerto Rico and a half-dozen handblown glass balls from our days together in London. Only the tinsel went onto the tree without my hanging a memory upon it.

Richard, as he did every year, put the angel on top of the tree. But this year, I had to help him. I felt him, so physically weak, tremble against me, and we looked at each other with alarm. Then we just held each other. Knowing that he was going to die, and knowing how little we knew about what was ahead of us, gave us an intimacy unlike anything we had known before.

We drove nearly every day through Rock Creek Park, a great and beautiful park less than a block from our house. We looked for deer, which Richard inevitably caught sight of first, and followed the creek as far as we could; we saved the life of a box turtle wandering on the parkway. We found places off the tangled capillary roads of the park that we did not know existed, and knew ourselves freshly beholden to the park’s beauty for what it gave us now that we had not known we needed. A pleasure became a necessity.

We went one day to our old house in Georgetown, where we had lived for many years; we pulled up outside of it and sat in the car admiring the small pond we had built in the front yard. Building and stocking the pond had been a lesson in our differences, never more apparent than while debating what to do with the pond once the work on it had been completed. We had decided to buy water lilies. This entailed going to a water lily farm in Maryland, the kind of small adventure both of us loved. Neither of us knew anything about water lilies, so Richard described the size of our pond to the salesman, who, while polite, was less than impressed.

Richard said, “I think one plant will do.”

“I agree,” said the salesman. “Two would be more than you really need.”

“She will want at least seven or eight,” Richard said, nodding in my direction. “Why don’t we take three?”

We drove back to Washington with our three water lily plants on my lap, talking about what we didn’t know about water lilies. There was a silence for a while and then Richard said, “I trust you won’t go overboard with the goldfish?”

“Of course not,” I said indignantly. “I’ll get only as many as makes sense for the pond.” I looked at Richard, who looked deeply skeptical and then burst out laughing.

“Right,” he said. “I can only imagine. We’ll be feeding everything in the neighborhood that walks on four feet.”

I made up in goldfish for what I thought we lacked in water lilies. At least a hundred came to join us. Before two summers passed, the water lilies had taken over the pond and were on the move over the pond’s stone ledge. The fish flourished, despite the occasional electrical storm that left some of them fried and floating.

One evening, Richard brought a half-eaten goldfish into the kitchen and dangled it in front of my eyes. “Congratulations,” he said. “We’ve created alfresco dining for the raccoons. They eat here, tell their friends, and then take one for the road.” The fish continued to thrive, the raccoons continued to fish in our pond, and I never heard the end of it. Now, years later, I asked Richard if he remembered our trip to buy water lilies and the legions of goldfish I had gotten for the pond. He laughed out loud: How could I not? he said.

I think, until that moment—sitting in our car in front of our old house with its very small fish pond, watching the snow as it came down in great, beautiful flakes—I had not fully realized how wondrous laughter is, how fortunate we had been to have so much of it, so easily.

Christmas day was quiet and close. My mother was staying with us, and we had coffee and opened presents in front of the tree; the fireplace, now a source of mordant one-liners from Richard, had been cleaned and worked well. Richard gave me a pair of gold earrings from Newport, Rhode Island, with a note to wear them “in good times and in bad.” In the months, and then the years, to follow, I did exactly that. They became a bellwether of my moods and expectations: an amulet to act against bad days, a glyph of hope or delight during good ones. We had dinners with friends, and drove around our neighborhood looking at lighted Christmas trees in window bays, their joy up against the dark. It was a good Christmas, all things considered.

We saw in the new year with a finger of whiskey, shortbread, and a shiver of dread.

Ambinder had turned over Richard’s care to David Ettinger, a Hopkins specialist in lung cancer. He was to prove to be a very good doctor, open to the ideas of the scores of physicians and scientists we consulted from hospitals and laboratories across the country. Two of the scientists we consulted, Jim Watson of Cold Spring Harbor Laboratory and Bob Gallo, director of the Institute of Human Virology at the University of Maryland, had been friends of ours for many years. Jim contacted numerous scientists about their work, tracked down results from clinical trials that had not yet been published, invited me up to Cold Spring Harbor Laboratory to attend meetings on experimental cancer treatments, and introduced us to Judah Folkman at Harvard, whose treatment recommendations Richard and I believed prolonged Richard’s life by many months.

Bob Gallo, in addition to talking with scores of oncologists, gene therapists, and vaccine researchers, continued to grow—and to try to kill—Richard’s tumor cells in his own laboratory. He also introduced us to Jeff Schlom, a prominent cancer vaccine scientist at the National Cancer Institute, who together with his wife, Kathleen, was unbelievably helpful and kind to Richard and me; they became close friends, in a class by themselves.

The winter and spring of 2000 came and went and brought with them a generally quiet rhythm to our days. We spent our mornings and afternoons in the room across from our bedroom; it caught the best of the light coming into the house and became a room of our own, private and quiet and undisturbed. Richard worked on his laptop in a chair across from mine, and I read or wrote, did needlepoint, and watched the manuscript pages slowly accumulate for the book I was writing about exuberance—an odd topic, given what we were going through. Richard worked on scientific papers as well as on a short book, Cancer Tales, that he was writing about his experiences with lymphoma and lung cancer. In the evenings, we had dinner with friends or watched movies, or I would read and Richard would disappear into his study to work, often into the early hours of the morning.

Going to Hopkins for Richard’s appointments with Ettinger usually shattered the calm of our daily world. We were anxious driving there, anxious while we waited, and anxious, if not distraught, once Ettinger had spoken to us. We spent a great deal of time at the hospital. While Richard was getting his bloodwork and scans done, I worked on a needlepoint tapestry of entwining tulips that I cannot, now, bear to look at. Our time in the “infusion” room, where Richard received his chemotherapy, was better, and after a while, it did not seem so alien: Richard listened to Harry Potter books on tape and I read or did my needlework, we held hands, or we talked with other patients and their families.

Life unfolded, as it will. Richard continued to feel reasonably well during the spring of 2001, although his scans showed slow growth of the tumors in his lungs. At some point, it became clear that the chemotherapy was having no effect, so we pursued experimental treatment options. We spoke to a vaccine expert at Georgetown University, who said that Richard, because of his recent bone marrow transplant, was not eligible for the vaccine trial. If necessary, however, he said he would apply to the National Cancer Institute for a compassionate use waiver. The NCI research protocols made it absurdly difficult for Richard to participate, however: Could he give truly informed consent? This seemed to us to be on the other side of Alice in Wonderland; Richard was a physician and a scientist, he had a terminal illness, and he had conducted clinical studies for thirty years at the National Institutes of Health. If he couldn’t give informed consent, who could?

Fortunately, our friend Jeff Schlom, who is chief of the tumor immunology lab at the NCI, offered to help Richard with the inordinately complicated application procedure. In the meantime, Richard and Ettinger consulted with Judah Folkman and decided to try his treatment protocol, which was designed to limit the growth of the blood supply to tumors. There were, we were discovering, many options on the cusp of viability. Richard noted wryly that he loved being on the cutting edge of science, even if he turned out to be that edge.

Richard went through the standard treatments for lung cancer and then the experimental ones. He lived a year longer than had been predicted for his type of disease, a year that was a gift of science and the hard work of people who did everything they could to save Richard’s life. But the tumors in his lungs grew; they grew erratically, sometimes not for weeks or months, but they grew.

Science and medicine cannot be pushed beyond a certain point. Richard lived longer than initially expected because of the remarkable scientific times in which we live. He died because there are limits to knowledge. We knew these limits well—we saw them every day in studying and treating schizophrenia and depressive illnesses—and we were generally philosophical about them, Richard more so than I. Both of us, in our clinical teaching, had often quoted Sir William Osler, the first physician in chief at Johns Hopkins. “In seeking absolute truth we aim at the unattainable,” Osler had said, but we must be content with “broken portions.” I wanted the unattainable. I wanted Richard to live. I understood the concept of broken portions, but I wasn’t resigned to it.

The first daffodils came. We drove to the Tidal Basin early in the mornings and took in the cherry blossoms and, on occasion, drove to Theodore Roosevelt Island. Life was often normal, although in some ways more wonderful, as we knew that it was not at all normal. We continued our long drives through Rock Creek Park, usually taking Pumpkin, our basset hound, along and listening to the songs of Stephen Foster and Paul Robeson. These were small, shared passions—the park, the beauty of Washington, Foster and Robeson—and they gave a sustaining happiness to our days.

That spring, Richard was honored by his colleagues on three different occasions, and each was a source of great pleasure for him. Although the tributes were triggered by his likely death, he did not find them melancholic events. On the contrary, he could not have enjoyed them more. The first, a scientific meeting on schizophrenia, was dedicated to him by the psychiatrists working in Veterans Administration hospitals across the country. In their remarks, his colleagues described him as a “towering” figure in psychiatry, science, and medicine. He reveled in the “towering.”

To a person, they acknowledged him for his pioneering contributions to understanding the brain and schizophrenia, for improving the treatment of schizophrenia and other psychotic illnesses, and for his generosity as a teacher of young doctors and scientists. At a dinner in his honor, the director of the National Institute of Mental Health, now provost at Harvard, talked about Richard’s groundbreaking work in psychiatry. Then he said, to great laughter, that Richard’s good papers had been published in Science, his rejects in Nature. Richard loved every minute of the conference, as he loved an equally generous and warm day of tributes from his colleagues at Columbia University in New York, where he held a faculty appointment and had collaborated with many of the physicians and scientists.

The National Institutes of Health paid him the unusual tribute of hosting an all-day scientific symposium in his honor, followed by a dinner at the Army-Navy Club. Many of the world’s most distinguished neuroscientists talked about Richard’s influence on their work. They talked, as well, about his grace and formidable energy, his generosity as a mentor, and his scientific creativity. Richard was deeply moved by these tributes. I rarely saw him cry during the years I knew him, but at one point during the remarks I saw tears that he could not hold back. Respect from one’s peers is not for sale, and Richard, of all people, knew this.

Richard wrote in Cancer Tales that those days of recognition from his colleagues helped him get through his illness and face the prospect of death. He knew that he was loved; he knew he had made a difference. He believed that everyone has an obligation to give back in life, particularly those who have had advantages. Listening to the heartfelt appreciation of so many of the scientists he had trained or worked with made him believe that he had given back as best he could. He did not write or talk much about death, but during this time of tributes he did:

Many people think about death every day. Call me shallow—many have—but it is a rare day when I concern myself with my own death. Long ago, I decided that if I paid my debts I would not worry about death. As I was growing up, it occurred to me that I had been very fortunate—I had been given a great deal and owed a large debt. I had been healthy, born and raised in the United States, was well-educated, privileged to go to medical school and finish my training. By the time I was thirty-three years old and developed Hodgkin’s disease, I believed I had performed a sufficient number of good deeds that I had paid back my debts—I might even be even. Being successfully treated for Hodgkin’s left me in the hole again. So I spent the next few years getting myself on the right side of the ledger. Certainly there were many times I did things that hurt others or committed sins of omission, but by my accounting I stayed ahead and feel I am still ahead. For me, not being in debt means I do not have to be concerned about death.

Richard’s views on death were not my own—death to me is unimaginable and horrifying—but he gave me an enviable slant on it.