My Incurable Cancer Compels Me to Imagine How My Sons Might Look After I’m Gone
By Adam Philip Stern
I stare at my five-year-old trying to imagine how he’ll look in the future. I can see him fully formed in grade school. I can even start to make out his appearance as a tween, how his face will fill out and then narrow again as mine did. I have more trouble morphing him into a teenager, though, and I fail to imagine him as an adult every single time.
My one-year-old is still such a beautiful blank canvas that I can’t even picture him as a preschooler. I admit that this hurts. I both love and hate this mental exercise, but I force myself through it because I don’t know how many of these transitions I’ll get to see with my own eyes.
I have a form of advanced kidney cancer that currently has no cure.
The field is changing fast, though. I recently had my four-year cancerversary — an annual reminder that I’ve survived this long but know next to nothing about what comes next. After looking at known survival curves at the time of diagnosis, I never expected to be here in 2022. My next scans could still reveal devastating metastatic spread. Alternatively, I could keep plodding along — medication by medication, procedure by procedure — slowly and deliberately killing off the little parts of myself that won’t stop trying to take over my body.
Four years past my diagnosis and well enough to write this piece, I’ve been more fortunate than most people with the same illness. But I know that eventually, the streak will end, as it does for all of us. Someday I’ll run out of lung and kidney to spare, or we’ll find the disease in a place we can’t reach. A new metastasis in my brain is my worst fear. Even as a biological psychiatrist, I can’t begin to tell someone where the biological function of a brain ends and the soul of a person begins.
A friend within the cancer community told me he imagines our lives as different than most people’s because others can look at the decades ahead as a series of tracks that will lead them forward. For us, he said, we are moving forward as the track is still being built, and we simply have to hope that the researchers in our field stay one step ahead of our particular disease burden.
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I know that this train can crash at any moment, so I spend energy traveling through time in my mind. I see my older son and think back to how little I remember from my own life when I was five: it’s a series of blurs and associated feelings with a very finite number of well-formed memories. Most of them were traumatic events. If I died today, years from now that’s all that would be left for my older son. For my baby, there would be nothing but iPhone videos, relatives’ stories, and my own writing to him.
People tend to think of grief as a reaction to a grave loss that’s already happened, but could it be that it’s formed just as readily as an anticipation of that loss? When I take a step back and look at my own obsessions about the lives I’ll likely never get to see unfold, I think it’s grief by proxy for the loss my boys haven’t even endured yet.
My wife largely functions under the premise that we have to live our lives as fully as we can while we can, and on the surface, I agree. Deeper down, though, I’m splitting my time between the here and now and the infinite permutations of an unknown future.
I’m helping get the kids ready for bed while trying to imagine them graduating from college. I’m reading them a bedtime story while wondering if they’ll ever read the book I wrote for them when they come of age. I’m brushing the hair out of their faces to kiss their foreheads while speculating about the kind of people they’ll decide to spend their own lives with two or three decades from now.
It is, of course, possible that just as I hadn’t imagined surviving to my fifth year with this disease, I’ll surprise myself again by living long enough to see these occasions with my own mortal eyes. Outwardly, I live my life as though that’s the case. It’s only under the surface of my consciousness that I have access to the time machine — the cognitive device that can very rarely, preciously give me access to that fourth dimension.
I find that it’s only when the light is very dim and the drumbeat of the world steadies to a faint hum that I can even tap into it properly and, just for a moment, experience those unfulfilled lifetimes. The indescribable feelings that accompany those microdoses of clarity seem to be equal parts bliss and agony, but even so, they’re my best and only defense in times like these.
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Adam Philip Stern is an assistant professor of psychiatry at Harvard Medical School and the author of Committed: Dispatches from a Psychiatrist in Training. His writing about the intersection of being a patient, doctor, and father has been published in the New York Times, Boston Globe, and New England Journal of Medicine. Adam is also the co-host of the podcast Characters on the Couch, a Zcast production.