Ирвин Ялом - The Schopenhauer Cure

ulcerated, five nodes? Be straight. Talk to me as if I were a layman.»

«Meaning bad news. It`s a sizable melanoma, and it has spread to the nodes. The

real danger here is more distant spread, but we won`t know that till the CT scan which

I`ve arranged for tomorrow at eight.»

Two days later they continued their discussion. Bob reported that the CT scan was

negative—no evidence of spread elsewhere in the body. That was the first good news.

«But even so, Julius, this adds up to a dangerous melanoma.»

«How dangerous?» Julius`s voice cracked. «What are we talking about? What kind

of survival rate?»

«You know we can only address that question in terms of statistics. Everyone is

different. But for an ulcerated melanoma, four millimeters deep, with five nodes, the

statistical charts show a five–year survival of less than twenty–five percent.»

Julius sat for several moments with head bowed, heart pounding, tears in his eyes,

before asking, «Keep going. You`re being straight. I need to know what to tell my

patients. What will my course be like? What`s going to happen?»

«It`s impossible to be precise because nothing more will happen to you until the

melanoma recurs somewhere in the body. When it does, especially if it metastasizes, then

the course might be quick, perhaps weeks or months. As for your patients, hard to say,

but it would not be unreasonable to hope for at least a year of good health ahead of you.»

Julius nodded slowly, head down.

«Where`s your family, Julius? Shouldn`t you have brought someone in with you?»

«I think you know about my wife`s death ten years ago. My son is on the East

Coast and my daughter in Santa Barbara. I`ve said nothing to them yet; I didn`t see any

sense in disrupting their lives unnecessarily. I generally do better licking my wounds in

private anyway, but I`m pretty sure that my daughter will come up immediately.»

«Julius, I`m so sorry to have to tell you all this. Let me end with a little good news.

There`s a lot of energetic research going on now—perhaps a dozen very active labs in

this country and abroad. For unknown reasons the incidence of melanoma has risen,

almost doubled in the last ten years, and it`s a hot research area. It`s possible that

breakthroughs are close at hand.»

For the next week Julius lived in a daze. Evelyn, his daughter, a classics professor,

canceled her classes and drove up immediately to spend several days with him. He spoke

at length to her, his son, his sister and brother, and to intimate friends. He often woke in

terror at 3A.M. , crying out, and gasping for air. He canceled his hours with his individual

patients and with his therapy group for two weeks and spent hours pondering what and

how to tell them.

The mirror told him he didn`t look like a man who had reached the end of his life.

His three–mile daily jog had kept his body young and wiry, without an ounce of fat.

Around his eyes and mouth, a few wrinkles. Not many—his father had died with none at

all. He had green eyes; Julius had always been proud of that. Strong and sincere eyes.

Eyes that could be trusted, eyes that could hold anyone`s gaze. Young eyes, the eyes of

the sixteen–year–old Julius. The dying man and the sixteen–year–old gazed at each other

across the decades.

He looked at his lips. Full, friendly lips. Lips that, even now in his time of despair,

were on the edge of a warm grin. He had a full head of unruly black curly hair, graying

only in his sideburns. When he was a teenager in the Bronx, the old white–haired, red–faced, anti–Semitic barber, whose tiny shop was down his street between Meyer`s candy

store and Morris`s butcher shop, cursed his tough hair as he tugged at it with a steel comb

and cut it with thinning shears. And now Meyer, Morris, and the barber were all dead,

and little sixteen–year–old Julius was on death`s call sheet.

One afternoon he tried to attain some sense of mastery by reading the melanoma

literature in the medical school library, but that proved futile. Worse than futile—it made

things more horrendous. As Julius apprehended the truly ghastly nature of his disease, he

began to think of melanoma as a voracious creature sinking ebony tendrils deep into his

flesh. How startling it was to realize that suddenly he was no longer the supreme life

form. Instead he was a host; he was nourishment, food for a fitter organism whose

gobbling cells divided at a dizzying pace, an organism that blitzkrieged and annexed

adjacent protoplasm and was now undoubtedly outfitting clusters of cells for cruises into

the bloodstream and colonization of distant organs, perhaps the sweet friable feeding

grounds of his liver or the spongy grassy meadows of his lungs.

Julius put aside the reading. Over a week had gone by, and it was time to move

past distraction. The hour had come to face what was really happening. Sit down, Julius,

he told himself. Sit down and meditate upon dying. He closed his eyes.

So death, he thought, has finally made its appearance on stage. But what a banal

entrance—the curtains jerked open by a roly–poly dermatologist with a cucumber nose,

magnifying glass in hand, and costumed in white hospital coat with his name stitched in

dark blue letters upon his upper breast pocket.

And the closing scene? Destined, most likely, to be equally banal. His costume

would be his wrinkled pinstriped New York Yankees night–shirt with DiMaggio`s

number 5 on the back. The stage set? The same queen–sized bed in which he had slept for

thirty years, crumpled clothes on the chair beside the bed and, upon his bedside table, a

stack of unread novels unaware that their time would now never come. A whim–pering,

disappointing finale. Surely, Julius thought, the glorious adventure of his life deserved

something more...more...more what?

A scene he had witnessed a few months ago on a Hawaiian vacation came to mind.

While hiking he had quite by chance come upon a large Buddhist retreat center and saw a

young woman walking though a circular labyrinth, constructed of small lava stones.

Reaching the center of the labyrinth she stopped and remained motionless in a lengthy

standing meditation. Julius`s knee–jerk reaction to such religious ritual was not charitable,

generally falling somewhere in the territory between ridicule and revulsion.

But, now, as he thought about that meditating young woman, he experienced softer

feelings—a flood of compassion for her and for all his fellow humans who are victims of

that freakish twist of evolution that grants self–awareness but not the requisite

psychological equipment to deal with the pain of transient existence. And so throughout

the years, the centuries, the millennia, we have relentlessly constructed makeshift denials

of finiteness. Would we, would any of us, ever be done with our search for a higher

power with whom we can merge and exist forever, for God–given instruction manuals,

for some sign of a larger established design, for ritual and ceremony?

And yet, considering his name on death`s roster, Julius wondered whether a little

ceremony might not be such a bad thing. He jerked away from his own thought as if

scorched—so thoroughly dissonant was it with his lifelong antagonism to ritual. He had

always despised the tools by which religions strip their followers of reason and freedom:

the ceremonial robes, incense, holy books, mesmerizing Gregorian chants, prayer wheels,

prayer rugs, shawls and skullcaps, bishop`s miters and crosiers, holy wafers and wines,

last rites, heads bobbing and bodies swaying to ancient chants—all of which he

considered the paraphernalia of the most powerful and longest–running con game in

history, a game which empowered the leaders and satisfied the congregation`s lust for

submission.

But now, with death standing next to him, Julius noted that his vehemence had lost

its bite. Maybe it was simplyimposed ritual he disliked. Perhaps a good word could be

found for a little personal creative ceremony. He was touched by the newspaper

descriptions of the firemen at ground zero in New York, stopping, standing, and

removing hats to honor the dead as each pallet of newly discovered remains was brought

to the surface. Nothing wrong with honoring the dead...no, not the dead, but honoring the

life of the one who died. Or was it something more than honoring, more than sanctifying?

Wasn`t the gesture, the ritual of the firemen, also signifying connectivity? The

recognition of their relationship, their unity with each victim?

Julius had a personal taste of connectivity a few days after his fateful meeting with

his dermatologist when he attended his support group of fellow psychotherapists. His

fellow doctors were stunned when Julius revealed the news of his melanoma. After

encouraging him to talk himself out, each group member expressed his shock and sorrow.

Julius couldn`t find any more words, nor could anyone else. A couple of times someone

started to talk but did not, and then it was as if the group agreed nonverbally that words

were not necessary. For the final twenty minutes all sat in silence. Such prolonged

silences in groups are almost invariably awkward, but this one felt different, almost

comforting. Julius was embarrassed to admit, even to himself, that the silence felt

«sacred.» Later it occurred to him that the members not only were expressing grief but

were also removing their hats, standing at attention, joining and honoring his life.

And perhaps this was a way of honoring their own lives, Julius thought. What else

do we have? What else other than this miraculous blessed interval of being and self–awareness? If anything is to be honored and blessed, it should simply be this—the

priceless gift of sheer existence. To live in despair because life is finite or because life

has no higher purpose or embedded design is crass ingratitude. To dream up an

omniscient creator and devote our life to endless genuflection seems pointless. And

wasteful, too: why squander all that love on a phantasm when there seems too little love

to go around on Earth as it is? Better to embrace Spinoza`s and Einstein`s solution:

simply bow one`s head, tip one`s hat to the elegant laws and mystery of nature, and go

about the business of living.

These were not new thoughts for Julius—he had always known of finiteness and

the evanescence of consciousness. But there is knowing andknowing. And death`s

presence on the stage brought him closer to really knowing. It was not that he had grown

wiser: it was only that the removal of distractions—ambition, sexual passion, money,

prestige, applause, popularity—offered a purer vision. Wasn`t such detachment the

Buddha`s truth? Perhaps so, but he preferred the path of the Greeks: everything in

moderation. Too much of life`s show is missed if we never take off our coats and join in

the fun. Why rush to the exit door before closing time?

After a few days, when Julius felt calmer with fewer sweeps of panic, his thoughts turned

to the future. «One good year» Bob King had said, «no guarantees, but it would not be

unreasonable to hope for at least a year of good health.» But how to spend that year? One

thing he resolved was not to make that one good year a bad year by grieving that it was

not more than a year.

One night, unable to sleep and craving some comfort, he restlessly browsed in his

library. He could find nothing written in his own field that seemed even remotely relevant

to his life situation, nothing pertaining to how should one live, or find meaning in one`s

remaining days. But then his eye fell upon a dog–eared copy of Nietzsche`sThus Spake

Zarathustra. Julius knew this book well: decades ago he had thoroughly studied it while

writing an article on the significant but unacknowledged influence of Nietzsche on

Freud.Zarathustra was a brave book which more than any other, Julius thought, teaches

how to revere and celebrate life. Yes, this might be the ticket. Too anxious to read

systematically, he flipped the pages randomly and sampled some of the lines he had

highlighted.

«To change ‘it was` into ‘thus I willed it`—that alone shall I call redemption.»

Julius understood Nietzsche`s words to mean that he had to choose his life—he had

to live it rather than be lived by it. In other words he should love his destiny. And above

all there was Zarathustra`s oft–repeated question whether we would be willing to repeat

the precise life we have lived again and again throughout eternity. A curious thought

experiment—yet, the more he thought about it, the more guidance it provided:

Nietzsche`s message to us was to live life in such a way that we would be willing to

repeat the same life eternally.

He continued flipping the pages and stopped at two passages highlighted heavily in

neon pink: «Consummate your life.» «Die at the right time.»

These hit home. Live your life to the fullest; and then, and only then, die. Don`t

leave any unlived life behind. Julius often likened Nietzsche`s words to a Rorschach

exam; they offered so many opposing viewpoints that the readers` state of mind

determined what they took from them. Now he read with a vastly different state of mind.

The presence of death prompted a different and more enlightened reading: in page after

page, he saw evidence of a pantheistic connectedness not previously appreciated.

However much Zarathustra extolled, even glorified solitude, however much he required

isolation in order to give birth to great thoughts, he was nonetheless committed to loving

and lifting others, to helping others perfect and transcend themselves, to sharing his

ripeness.Sharing his ripeness —that hit home.

ReturningZarathustra to its resting place, Julius sat in the dark staring at the lights

of cars crossing the Golden Gate Bridge and thinking about Nietzsche`s words. After a

few minutes Julius «came to»: he knew exactly what to do and how to spend his final

year.He would live just the way he had lived the previous year—and the year before that

and before that. He loved being a therapist; he loved connecting to others and helping to

bring something to life in them. Maybe his work was sublimation for his lost connection

to his wife; maybe he needed the applause, the affirmation and gratitude of those he

helped. Even so, even if dark motives played their role, he was grateful for his work. God

bless it!

Strolling over to his wall of file cabinets, Julius opened a drawer filled with charts and

audiotaped sessions of patients seen long ago. He stared at the names—each chart a

monument to a poignant human drama that had once played itself out in this very room.

As he surfed through the charts, most of the faces immediately sprang to mind. Others