Wchicken routine The echocardiogram revealed a large mass next to my heart, which the radiologist thought might be a diaphragmatic hernia — part of my stomach bursting through my diaphragm to press on the sac that contains my heart.
“Put this can of diet down Dr Pepper and hop on the table for another echocardiogram before the soda bubbles in your stomach.”
So I did. However, the resulting images showed that the mass had no telltale sign of bubbles bursting in my stomach that would support a hernia diagnosis. A few weeks later, an MRI scan, which has a much better resolution, revealed that the mass was indeed inside the pericardial sac and was very large – about the size of that soda can. Even with this massive gas pressure on my heart, I had no symptoms and could exercise to my full capacity. I felt great.
The doctors told me that the mass was most likely a teratoma, a mass of cells that is not usually malignant. Their gaze was sunny. bobbing to the music South PacificMy cardiologist said, “We’ll take that orange right out of your chest and send you on your way.”
While I was recovering from surgery, the pathology report came back and the news was bad – it wasn’t a benign teratoma at all, but a malignant cancer called synovial sarcoma. Because of its location embedded in the wall of my heart, the surgeon was not able to remove all of the cancer cells. Doing so will make my heart unable to pump blood. My oncologist told me to expect to live another six to 18 months.
I was totally angry with the universe. heart cancer? Who the hell gets heart cancer?! Is this some kind of terrible metaphor? This is what will take me away from my beloved family, dear friends and colleagues? I simply cannot accept it. I was so angry, I could hardly see.
[And now comes the part where I’m weeping while I type.]
Five years ago, I met Dina and we fell deeply in love with each other. This wasn’t just ‘chemistry’. It was closer to particle physics – it revealed the subatomic properties of love. Dina raised me with her pure and unconditional love, kindness, beauty, optimism, and intense intelligence. She’s the best wife anyone could ever want, and she’s so much better than I deserve. Leaving her behind is going to be the hardest part of this whole awful situation.
Up until the moment of this diagnosis six months ago, I was the luckiest guy in town. My twins, Jacob and Natalie, have been nothing but a delight for 25 years. I have been fortunate to have a long career in academic sciences with the freedom to pursue my own ideas, a gift like no other. My good friends are a constant source of joy and amusement. By any reasonable measure, I’ve lived a wonderful life full of love, creativity, and adventure.
I may be on the verge of death, but I’m still obsessed with science, and so I think about what preparing to die has taught me about the human mind. The first thing, which is obvious to most but had to be brought home forcefully to me, is that it is possible, even easy, to occupy two seemingly contradictory states of mind at the same time. I am at the same time angry about my cancer, and deeply grateful for all that life has given me. This goes against the old idea in neuroscience that we engage one mental state at a time: we are either curious or fearful—either “fight or flight” or “relax and digest” depending on some general modulation of the nervous system. But our human brains are more subtle than that, and so we can easily live in multiple complex, even paradoxical, cognitive and emotional states.
This brings me to a second view: the deep truth of being human is that there is no objective experience. Our brains are not designed to measure the absolute value of anything. Everything we perceive and feel is colored by expectations, comparisons, and circumstances. There is no pure sensation, only sensation-based inference. Thirty minutes fly by in a conversation with a good friend, but it seems endless when waiting in line at the DMV. The fat gain you got at work sounds great until you know your coworker got double yours. Foreplay by your sweetheart during a loving and continuous time feels warm and cheerful, but the same touch given during the middle of a heated argument seems annoying, arrogant, and violated.
If someone had told me a year ago, when I was fifty-nine years old, that I had only five years left to live, I would have been devastated and felt the deception of fate. Now the prospect of another five years seems to me an impossible gift. With five more years I could have fun with all my people, get some important work done, and still be able to travel and savor the sweetness of life. The point is that, in our minds, there is no such thing as objective value, even for something as basic as five years of life.
The final insight into my situation is the most accurate, but it’s also the most important. Although I can prepare for death in all sorts of practical ways—arranging my finances, updating my will, writing letters of reference to support my lab apprentices after my departure—I cannot imagine the entirety of my death, or the world without me in it, in any profound or meaningful way. My mind flipped across the surface of my impending death without really getting involved. I don’t think this is a personal failure. Rather, it is a simple consequence of having a human brain.
The field of Neuroscience has changed dramatically in the 43 years since I joined it. I learned that the brain is basically a reaction: stimuli hit the sense organs (eyes, ears, skin, etc.), these signals are transmitted to the brain, a little arithmetic happens, some neurological decisions are made, then impulses are sent along the nerves to the muscles , which contract or relax to produce behavior in the form of movement or speech. We now know that instead of simply responding to the outside world, the brain spends a lot of its time and energy making active predictions about the future – mostly the next few moments. Is that baseball flying in the air going to hit my head? Am I likely to get hungry soon? Is this approach to the stranger friend or foe? These predictions are deeply rooted, automatic, and unconscious. They cannot be stopped by willpower alone.
Because our brains are structured to predict the near future, they presuppose that there will, in fact, be, is being near future. In this way, our brains are polished to prevent us from imagining the totality of death.
If I am allowed to speculate—and I believe that a dying person should be granted such an exemption—I will assert that this fundamental cognitive limitation is not limited to those of us preparing for imminent death, but is a pervasive imbalance that has profound implications for the practice of religious thought across cultures. Almost every religion has a concept of an afterlife (or its epistemological cousin, reincarnation). Why are afterlife/reincarnation stories found all over the world? For the same reason, we can’t Oh really Imagine Our Death: Because our brains are built on the mistaken assumption that there will always be the next moment to predict. We can only imagine that our consciousness lasts.
While not every religion contains explicit stories of an afterlife/reincarnation (Judaism is a notable exception), most of the world’s major religions, including Islam, Sikhism, Christianity, Taoism, Hinduism, and arguably, even Buddhism. In fact, much religious thought takes the form of a bargain: follow these rules in life, and you will be rewarded in the afterlife or favorably from reincarnation or by merging with the divine. What would the world’s religions be like if our brains were not organized to imagine consciousness persisting? And how can this change our human cultures, which have been so powerfully shaped by religions and the conflicts between them?
As I think about these questions, I am also thinking about my situation. I am not a person of faith, but as I prepare to die, I have a renewed respect for the ongoing and widespread appeal of afterlife/reincarnation stories and their eventual neurobiological roots. I’m not sure, after all, whether belief in afterlife/reincarnation stories is a trait or a bug in human perception, but if it’s wrong, it’s something I sympathize with. After all, how strange would it be for a manatee or a tapeworm to return? What a special joy it was to see Dina and my children again after my departure.
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