His death had been expected for weeks. Just out of his teens he never complained, the girls reminisced later. The leukemic weeds in his blood starved his body of fight and life. His parents stood by his bed as he lay dying. His breathing quickened over a quarter of an hour, then slowed, became irregular and ceased. He died. Death to those inexperienced can be a little surprising in its understatement. Nothing much happens. These parents showed little shock. No hysterics. Numbed, exhausted. In the end all deaths are alike, but no stories the same.

This story was twice memorable.

The first was the father. Some minutes before his son died, the father spoke. The force of his words was not their content. Rather, in a detached almost unfeeling tone he said: Can't you take my life and give it to him. The exhausted simplicity was its sincerity. No hysteria nor melodrama. Emotions stripped of superfluous flesh. It was a precise statement of fact, as we stood around in the shadows and glimpsed love.

The other memory was that the doctor cried. He usually didn't. Instinctively he turned to hide in the bundles of laundry. Is a doctor not meant to show his emotions, not to cry? It was not for the death of a patient. We knew that he had to die. The tears were for the unbearable pain of parents losing a child. For the father's piercing and dignified expression of love. For the parents helplessly watching the life of their child ebb, slip, fade.

I do not understand death. Jewish or not. But I like funerals. Especially Jewish ones. I like their solemnity and seriousness. One is forced to contemplate life's frivolousness and transience. To watch mourners mourn. For whom do we mourn? I like the Jewish tradition of burial. It rings true. From dust to dust. Adam came from Adamah (Hebrew for soil) and unto it we will return. I am comfortable with the notion of my flesh being decomposed and reorganized by worms and microbes, and if luck will, become next year's rose. A reincarnation, if only of my flesh.

Cancer is a wretched, wretched disease. Not necessarily worse than other deadly illnesses, but particularly wretched.

Cancer has unique features amongst G-d's pantheon of tribulations. Its very biology stems from a loss of control. Rampant multiplication and uncontrolled growth. The body turning on itself. The cancerous cell, once one of our own—it still is in fact—but now beyond our control. Control is life—loss of is death. This truism is in a sense as broad a description of life at all levels of existence as one can get. From the heavenly spheres in their orbits to our bodily functions, control is the key to success. And this is why we so fear cancer. Our psyche and soul shudders at losing control. Some believe that by force of will we can control the body with the mind. The wards are full of stories of patients staying alive until a loved one arrives from overseas or a child getting married—then relaxing, letting go, and dying.

Yet the reverse can be true. Especially in young people where an otherwise healthy body keeps the organism alive long after the cancer has gained substantial control and the will has withered. The dying is prolonged. The suffering interminable. We had a young man with widespread bowel cancer. His once meaty frame was emaciated except for a distortion in his midriff where liver growths bulged through. We all thought of euthanasia. His suffering seemingly senseless. He wasn't a talker so we never knew what went on inside. No profound thought, nor bitter regret passed his lips—only a thank you after another dose of morphine for the wretched pain. An only child of Italian immigrants who came to this great island filled with hope. No hope now. There are no miracles. His death was inevitable. Why not a simple injection with heads turned the other way? But life is life. My Jewish alarm bell rang with the unassailable Talmudic logic that since the value of life is limitless so therefore one hour equals one minute equals one second. Maybe he was destined to speak the truth a day after the would-be injection. Maybe he had it all along but was too shy to share it.

Our parameters are to keep the living living, although we are not obliged to prolong the act of dying. When does a living become a dying? When hope dies? Hasten his death we did not, but neither did we strive officiously to prolong it. As a group Jewish patients seem to fight ever more vigorously and neurotically for life. Seeking third, fourth opinions. Maddening demands for more treatment. Whence this passion to live? We are promised spiritual eternity, so why not a fatalism? I am uncertain. Maybe the simple truth is—all we have and know is Life. G-d told us: “I have put before you Life and Death, choose Life.” Even without G-d.

If there is an art to helping the sick and dying it lies in saying little but listening much. Especially important is to generate great confidence in patients. If achieved though, this confidence can paradoxically create a sort of addiction. A dependence on the doctor. Energy is transferred and the frail are supported by the strong. The focus of the addiction is likened to an antidote to fear.

Fear is the overriding emotion of cancer. Again the notion of loss of control surfaces. Fear of that. Fear of helplessness. Fear of the unknown. Fear of death.

When the end is near and the patient is frightened it is time to sit down once more and hold hands. Ask some questions and turn the conversation. Often we are asked—What should I do? I'm so tired. The answer gently is to let go. Give permission not to fight. You've done everything. There's nothing else to do. Shut your eyes and don't struggle. It's not painful to let go. Let sleep come, enfold you.

Yet as is said, in the midst of death there is life. We recently lost a young mother. Her parting words to her husband were—Don't let the kids call anyone else Mum. A final cry laying possession to her heritage. And a grandfather on chemotherapy calling for the doctor while suspiciously sending out the relatives. What curly question was coming? Listen, he said, do you know anyone for my granddaughter? Matchmaking while dying. A person's life story is told. Albeit not formally. Bits and pieces come out as we prepare the family. Information is garnered. A picture is built up. As much the behavior of friends and family paying tribute to the sort of person. Generous and befriended, or empty and lonely? Some lives ordinary, some deaths a celebration of life.

In a peculiar yet obvious way dying is the same process as living except that it is compressed by the pressure of time. Confronting our mortality is the common denominator. The same uncomprehending fears. For most of us our lives are swept along without much thought to such matters, occasionally punctuated by a funeral though quickly forgotten by the next dinner party. Conversely, there is the truism that we live as we die. If brave, bravely. If profound. If dignified. If bitter. Uncommonly do we see dramatic transformations.

Most patients know their time is limited when the symptoms start to accumulate. Many pretend.

Denial is part and parcel of living. We all know we are going to die sometime. But in health we parrot and parry death off into the future. We deny, or at least prioritize in order to function. To be happy. Is any happiness we snatch from life merely the bravado born of an inevitability?

Denial has a role in cancer, is healthy and protective. Like the body's immune system in fighting disease, so I believe is denial present to protect our psyche. I do not think all denial should be broken down. I don't think the ramparts need be smashed in order to get at the truth. The truth for some is ugly, bloody, and awful. Hope is better. Every consultation should be tempered with a hopeful thought. Every bad “truthful” investigation should have an antidote of hope, even if it encourages denial.

Take one day at a time—or live as if there is no tomorrow.

Truth is not the be all and end all. The Bible offers a proof. In Genesis after the squabble over the birthright, Isaac says to Esav—“My time is close, but I do not know when.” G-d shows us his merciful face in denying us the knowledge of when we will die. Even his prophets had not this insight. It is a hiatus of ignorance into which we can blissfully deny. Exceptions prove the rule—those facing execution and those by their own hand. It is a necessary mercy. Nonetheless relatives more than patients often ask: How long, doctor? The answer is invariably vague by definition. We cannot know.

In the end what do we have? Everyone dies. Dying is misery. Life is relatively happy. One goes to hospital to get better or to die. We accept the situation—there is no choice.

Is love an antidote to death? Hardly. The more we love, the more painful death is. They are flip sides of the same coin. We can be intellectual and grieve (correctly) over the deaths in Rawanda but they don't hurt us, not really, not as if they were our loved ones.

In the cancer ward there is so much unhappiness and misery. A doctor or nurse can hold one hand at a time. Can help a little. Then the helper takes leave with a heavier weight to bear—but through good health recovers. What if, I have wondered, the helper had to shoulder and imbibe all the misery of the ward's suffering alone?

Like a Lamed-vav, the thirty-six Just Men in each generation upon whom, Tradition has it, the world is precariously balanced. For into their hearts are poured all our griefs, and if even one of them were lacking, then humankind would be extinguished with unrequited suffering. Happiness is not a counterbalance. The Just Men are ordinary people who often do not recognize themselves. “When an Unknown Just rises to Heaven,” an Hasidic story goes, “he is so frozen that G-d must warm him for a thousand years between His fingers, before his soul can open itself to Paradise. And it is known that some remain forever inconsolable at human woe, so that even G-d Himself cannot warm them. So from time to time the Creator, Blessed be His Name, sets the clock of the Last Judgement forward by one minute.”¹

In the final analysis I do not understand death nor life. The comprehension seems to be forever just out of reach of my grasping fingers. Ephemeral, evanescent insights slip away before pen is put to paper. Absurdity and its corollary Hedonism is one solution to the conundrum. A belief in afterlife is another. That the soul is indestructible and must continue in one form or another—it's the Jewish tradition, so I accept it although I do not understand. I challenge it since doubt is the shadow of faith. Or is doubt really faith's elixir? In challenging, groping, searching, the answers go a little deeper at each question.

The dead, dying, and surviving show most clearly the paradox that is life. Life is Joy and Misery. Life is Physical and Spiritual. Life is Life.

These are too many words. In the end there are just stories to listen to and a job to be done.

Saith kohelet.