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“move as fast as possible in the opposite direction.” Some advice can actually be taken.
    Even in the world of sanity and modernity, though, it often cannot. Extremely well–informed people also get in touch to insist that there is really only one doctor, or only one clinic. These physicians and facilities are as far apart as Cleveland and Kyoto. Even if I had possession of my own aircraft, I would never be able to assure myself that I had tried everyone, let alone everything. The citizens of Tumortown are forever assailed with cures, and rumors of cures. I actually did take myself to one grand palazzo of a clinic in the richer part of the stricken city, which I will not name because all I got from it was a long and dull exposition of what I already knew plus (while lying on one of the fabled establishment’s examination tables) a bugbite that briefly doubled the size of my left hand: completely surplus even to my pre–cancerous requirements but a real irritation to someone with a chemically corroded immune system.

    Still and all, this is both an exhilarating and a melancholy time to have a cancer like mine. Exhilarating, because my calm and scholarly oncologist, Dr. Frederick Smith, can design a chemo–cocktail that has already shrunk some of my secondary tumors, and can “tweak” said cocktail to minimize certain nasty side effects. That wouldn’t have been possible when Updike was writing his book or when Nixon was proclaiming his “war.” But melancholy, too, because new peaks of medicine are rising and new treatments beginning to be glimpsed, and they have probably come too late for me.
    For example, I was encouraged to learn of a new “immunotherapy protocol,” evolved by Drs. Steven Rosenberg and Nicholas Restifo at the National Cancer Institute. Actually, the word “encouraged” is an understatement. I was hugely excited. It is now possible to remove T cells from the blood, subject them to a process of genetic engineering, and then reinject them to attack the malignancy. “Some of this may sound like space–age medicine,” wrote Dr. Restifo, as if he, too, had been rereading Updike, “but we have treated well over 100 patients with gene–engineered T cells, and have treated over 20 patients with the exact approach that I am suggesting may be applicable to your case.” There was a catch, and it involved a “match.” My tumor had to express a protein called NY-ESO-1, and my immune cells had to have a particular molecule named HLA–A2.Given this pairing, the immune system could be charged up to resist the tumor. The odds looked good, in that half of those with European or Caucasian genes do have that very molecule. And my tumor when analyzed did have the protein! But my immune cells declined to identify as sufficiently “Caucasian. Other similar trials are under review by the Food and Drug Administration, but I am in a bit of a hurry, and I can’t forget the feeling of flatness that I experienced when I received the news.
    Best perhaps to get these false hopes behind one quickly: It was in the same week that I was told that I didn’t have the necessary mutations in my tumor to qualify for any other of the “targeted” cancer therapies currently on offer. A night or so later I was emailed by perhaps fifty friends because 60 Minutes had run a segment about the “tissue engineering,” by way of stem cells, of a man with a cancerous esophagus. He had effectively been medically enabled to “grow” a new one. I excitedly contacted my friend Dr. Collins, father of genome-based treatment, who gently but firmly told me that my cancer has spread too far beyond my esophagus to be treatable by such a means.
    Analyzing the blues that I developed during those lousy seven days, I discovered that I felt cheated as well as disappointed. “Until you have done something for humanity,” wrote the great American educator Horace Mann, “you should be ashamed to die.” I would have happily offered myself