Monthly Archives: July 2026

Being Mortal

“Being Mortal” is a book I needed to read. It’s beautifully and poignantly written by Atul Gawande, a surgeon at Brigham and Women’s Hospital in Boston, where I spent several months in 2005/6 being treated for and cured of Burkitt Lymphoma. I first became aware of Gawande from the articles he’d written for the New Yorker magazine, but this is the first book of his that I’ve read. He writes with great compassion about the end of life of several of his patients, including that of his own father. He revisits the ancient Ars Moriendi updating it for the modern secular age. Gawande observes that advances in medicine and social organization have not kept pace with the art of dying. He points out that we accept death once it’s over, but it’s the period leading up to death that we find it difficult to deal with. Gawande has long been a proponent of including the patient in medical care and decision making, and here he extends that responsibility to the family. He recognizes that, all too often, doctors can give the impression that their superior knowledge and experience make them solely responsible for making decisions about treatment. This assumes that the doctor’s only job is to prolong life, but although that may be the doctor’s most important job, it is not the only one. Patients also need to retain agency over their lives, and to be able to take care of things important to them. All too often the family is caught between the two: should they listen to the doctor who has experience of treating many patients, or to the patient who is the only one who can say what matters to them. The patient knows that they only have a diminishing amount of time left to them, and may prefer to spend those days in familiar surroundings, with minimal pain, doing things that they care about. The patient may not wish to face the prospect of being subject to painful testing, invasive procedures, and spending time in the ICU; a prospect that  only postpones the ultimate. Even if patients escape this indignity, they may find themselves consigned to long-term care nursing homes. Often this is done for the benefit of a family that, for whatever reason, is unable to take on the responsibility of caring for the individual in their home. Here again there is a conflict between the interests of the caregiver and the patient. The caregiver may feel that they have to provide safe and consistent care, be it waking up the patient at set times for blood draws and taking vitals, dispensing regular doses of medication at set times during the day, and providing a controlled diet for breakfast, lunch, and dinner. Such a program is unlikely to be what the patient wants. Patients, while recognizing that they can’t do just what they did when younger, may still want to do things the caregiver won’t allow. This might include things such as sneaking the odd cigarette and cocktail! Caregivers would be correct in deeming that they are not in the best interests of the patient, but is the caregiver the only one who can decide that? Cannot the patient be allowed to shoulder some of the risk if doing so makes them happy?

Most people who have attended high school in the US, or its equivalent in the UK, will have learned about Maslow’s Hierarchy of Needs, having Self Actualization at its pinnacle. Gawande takes issue with this characterization of human needs as being applicable to everyone. It might be appropriate as a goal for high school students with their lives ahead of them, but for folks at the end of their lives they’ve probably done as much self-actualization as they need. They may be ready to look beyond the self and connect with something greater. As we age, we have more years behind us than ahead of us. We may feel the need to savor the past, atone for past transgressions, and share with others what they’ve learned along the way.

In a section on “Death with Dignity’ Gawande quotes the Stephen Jay Gould, the distinguished evolutionist from his 1985 essay “The Median isn’t the Message.” A few years earlier, in 1982, Gould had been given a diagnosis of Peritoneal Mesothelioma, a rare form of abdominal cancer, and given a life expectancy of 8 months. He actually died, 20 years later, of lung cancer, an entirely different illness. Gould writes:

“It has become, in my view, a bit too trendy to regard the acceptance of death as something tantamount to intrinsic dignity. Of course I agree with the preacher of Ecclesiastes that there is a time to love and a time to die – and when my skein runs out I hope to face the end calmly and in my own way. For most situations, however, I prefer the more martial view that death is the ultimate enemy – and I find nothing reproachable in those who rage mightily against the dying of the light.”

Gould’s case may be exceptional, but Gawande is concerned about the rise of the “Death with Dignity” movement, fearing that it may become the default option for the convenience of family and society when other options exist, including adult communities in the early stages of decline, or hospice towards the end. He recognizes that there are cases where it may be the best option, but questions the significant growth in rates of assisted suicide, currently  around 5% in Canada’s Quebec province and the Netherlands. Ultimately, Gawande comes down on the side of Hospice and Palliative Care (HPM). It is sobering to learn that HPM was only recognized as a specialty by the American Board of Medical Specialties in 2008, lagging the UK by more than 20 years who recognized it as a medical specialty in 1987. But it is also encouraging to learn that palliative care programs in US hospitals with 50 or more beds have increased from 20% in 2000 to 84% in 2022. A search of my health insurance’s website returned 59 HPM specialists in my geographic area.

For all this, addressing the complex issues surrounding the end of life is not easy. There is significant room for policy development in this area, and it is to be hoped that policy makers will read this book, understand it, and find the will to act upon its recommendations.

On Atheism

Every day seems to bring another news story that makes me hope that Trump’s hold on the Republican party is lessening, but it never seems to be enough to persuade his true believers. Why is this so? I think it was several years ago, in 2004, during John Kerry’s run against George W Bush, that I first noticed the tendency of Republicans to believe in any nonsense, so long as it supported their preconceived cultural tenets of selfish personal freedom, that the story is easy enough for even the simplest mind to understand and swallow, and that it is well funded and promoted. Democrats will always be hampered by having to deal with the real world and its complexities. The nonsense in that election, known as the “Swift Boat” controversy was that Kerry engaged in “stolen valor” when citing his experiences in the Vietnam war as reasons for his later anti-war activism. The conservative donors, including Bob Perry and T. Boone Pickens, who funded the Swift Boaters, later funded the Tea Party, which in turn paved the way for Trumpism and the MAGA movement.

So, what does this all have to do with Atheism? Although some of the leaders of the anti-war movement included Abbie Hoffman, an atheist, and Jane Fonda, who grew up atheist, there were others, including John Kerry and Dr. Martin Luther King, who were deeply religious. The issue that concerns me is that the opposing pro-war movement, having birthed MAGA, has also evolved to fully encompass the fundamentalist Christian right. And, after all, for all its good moral advice, if you can believe in the literal infallibility of the bible, including its fantastic stories of Adam and Eve, the Flood, and the parting of the Red Sea, then swallowing Trump’s lies is a piece of cake. I do not intend a blanket condemnation of Christianity, or even some of its stranger offshoots such as Mormonism. As Yuval Harari has observed, humanity’s sharing of common stories has certain evolutionary benefits, and it doesn’t matter if those stories are true or not. There are many upstanding Christians and Mormons who have displayed the courage to stand up to Trump. The problem that I take issue with is that flavor of fundamentalist Christianity espoused by influencers such as Lance Wallnau, Dutch Sheets, and the late Charlie Kirk. These folks enlist the beguiling forces of social media to spread lies that millions eagerly swallow because they feed an underlying yearning for answers.

In my case I grew up Church of England, and like my father was drawn towards the high church version of it. At Bryanston, my public school, I proudly became confirmed and used to voluntarily attend morning services in the school chapel. At Oxford, I would regularly attend mass at St. Mary Magdalene, an Anglo-Catholic high church, where we used the Anglican Missal instead of the usual Book of Common Prayer; we would genuflect before entering the pew and strike the chest at the appropriate time when reciting confession. Even though I was reading Physics, a scientific discipline that requires evidence for its theories, I saw no contradictions with my beliefs, or perhaps I didn’t want to see them. My church going fell into disuse after graduation, but I still considered myself Christian until I experienced an epiphany, fueled, it is true by LSD, while working the grape harvest in France in 1976. I saw myself as just another human in the universe, but connected to every other human in a vast grapevine network. It became clear to me that the only reason I believed in God was because I wanted to. In effect, it was as if God spoke to me and told me that he didn’t exist and there was no need to continue believing in him. It was perhaps like a child finding out that Father Christmas doesn’t exist, but it doesn’t matter because they’re still going to get presents!

Over the years I’ve been fortunate to have worked in different countries and meet people from walks of life whose experiences have been a lot harder than mine. From the barber who came aboard our ship when we docked in Douala, earning less in day than the price of a single beer in a local bar; from Palestinians living without agency under Israeli rule in Gaza; to young adults bowed down by mental challenges at a residential camp in upstate New York. The grapevine network may not be as obvious as it was that night in France, but the image has never left me. It’s easy to understand the bonds of family, neighbors, and friends that make up the local region of one’s network, less easy to understand what binds us to people that we have nothing in common with, that we may in fact be in opposition to, other than the simple truth that we are all human.

With this understanding, I find that I do not need a God to explain the mysteries of the universe. I acknowledge that other people’s upbringing and experiences may have led them to a different conclusion, that a God, or gods exist, but I see no need to dissuade them from these conclusions. I do not expect or need the  universe’s mysteries to be fully revealed to such an insignificant inhabitant as myself – no one understands such a self-evident truth as the workings of quantum mechanics, and perhaps as a race we are not equipped to do so, just as a two-dimensional being in Edwin Abbott’s Flatland is not able to perceive a three-dimensional universe.

What does this say for the future of the US? And indeed, of the UK? And of all countries where Trumpism and its fundamentalist religious cheerleaders have taken power or are on the rise. For those on the Left, railing against it on Facebook is unlikely to yield results, and those on the Right are deluding themselves if they think that their ALL CAPS POSTINGS conflating socialism with communism are having any effect other than shoring up the views of their followers and increasing their hatred of those that don’t agree with them; both groups are already safely ensconced in their bubbles. The sad fact is that people don’t like to change their minds.

Social media is addictive. Rare is the day when I do not find myself dumb-scrolling[1] Threads or some other platform for a quick fix. AI makes this more addictive, because it makes it a challenge to figure out what’s real or not. And, of course, “The Algorithm” knows what I’m interested in and makes sure to feed me more of it. But it’s missing the point to blame social media for what divides us. History tells us of many periods where the population has been similarly divided, from the conflict between Protestants and Roman Catholics begun by King Henry VIII in the 16th Century, ending with Catholic Emancipation in the late 18th Century, only to regenerate with the Northern Ireland troubles in the latter part of the 20th Century. The US’s first civil war, more commonly referred to as the “American Revolution” divided patriots and loyalists in the 18th Century, followed by its second civil war between the Union and the Confederacy in the 19th. Social media, in the form of pamphlets and broadsheets, certainly existed in the past, but since a large part of the population could not read, the messages would have, for the most part, be transmitted by gossip and preaching. It turns out that, humanity’s love of stories and its ability to share them is not only our species “evolutionary superpower,” as Yuval Harari has called it, but also its fatal flaw that may lead to the downfall of our modern society.

[1] I prefer the term “Dumb-scrolling” rather than the more common “Doomscrolling” because I’m not actively looking for bad news.

Day 74: Friday, July 24

Tagged as;

I completed updating my blog with entries from 2005/6 when I was being treated for Burkitt Lymphoma at Brigham and Women’s Hospital in Boston. I rearranged the menus a bit and shared the link with my small group of correspondents. I am pleased that some, at least, have taken me up on it.

I talked with Dr. Edwin Choy, director of the Sarcoma Oncology Center at MGH. He gave me the basic spiel about osteosarcoma and the limited progress made over the last decade. I would be getting adjuvant chemotherapy (adjuvant means a treatment that helps improve the effectiveness of a main medical action, such as surgery). I get the sense that he is not yet read in on my case. He knows I had Burkitts, but not the specific chemotherapy regimen. It turns out that, even though it was over 20 years ago, there’s a lifetime limit to the amount of certain drugs that my body can tolerate. Lozano is sure that he got all the infected bone and that it had not metastasized, so perhaps the treatment will be “watch and wait” versus immediate chemo. Choy knows my oncologist at B&W, Dr. Eric Jacobsen, as well as Dr. Eddy Chen, my oncologist at Emerson. My hope, although we didn’t discuss this, is that any infusions could be done at Emerson’s Naka Infusion Center.