An oncologist’s thoughts on what death cannot take away

l laid with my fingers interlocked, cradling my head, as I recently reclined on the grass in front of our home.

Soon, the 6-year-old joined me.

We stared at the sky as its color deepened to periwinkle.

Soon, we found ourselves transfixed by the tree that towered above us, its leaves fluttering in the breeze.

The entire canopy of foliage shimmered against the darkening sky.

“My boy,” I said, “Do you know what is strange to think?”

“That soon those leaves will all be gone?” he answered.

“That’s right,” I replied. “In a month or so, the green of the leaves will ripen into gold, and crimson, and yellow and all of them will fall to the ground.”

“And do you know what that teaches us?”

“No, Dad, what?”

“That beauty never lasts — that even the things we love the most will die away.”

The next moment, he asked to scooter to the park, and we were off.

I’ve reflected again and again, however, on that moment.

As a doctor — especially, of all things, an oncologist — I know these truths better than most.

Cancer, after all, speeds aging.

Crippled by tumors that invade the lungs, the abdomen, the brain, and even the heart, my patients — even when young — often appear much older.

I cared once for a man who was only 19 the first time we met — yet, within three years, the cancer that would soon take his life had rendered his mobility and, specifically, his breathing, more like that of an octogenarian than a teen.

Others of my patients elude their cancer, only to see age creep into their lives: the spine curls, the steps shorten, hearing falters, skin wrinkles, joints stiffen, the lungs harden, the heart tires, the mind weakens, and, in every cell and synapse, time exacts its toll.

Beauty never lasts.

Even what we love will die away.

Doctoring leaves this truth forever at my fingertips, forever in front of my eyes.

And yet.

In all my years as doctor, another truth has asserted itself, too — no less real for its subtlety, no less necessary for its quiet.

Even as all of us are fading forever away, yet sometimes a veil flutters and we sense that a deeper reality endures.

In spite of entropy and our own mortality — there are times and ways that we defy an apathetic universe, when we recognize or create a beauty that will last.

I am thinking of the couple who come, bent with age, yet hand in hand, to the exam room.

Of the cancer patient, bowed in her own pain, who nonetheless reaches out in compassion to the suffering man beside her.

Of the patient, with death approaching, who steels his resolve — determined to cultivate faith and meaning, come what may.

Of nurses who stayed extra hours in the pandemic as the only witnesses and fellow travelers to the ill as they neared the threshold out of life.

And of every brave soul I’ve known who, dying, has insisted that the extinguishing of life is not the end — that something lasts as the light of mortal life fades.

If our own molecules were lately the stuff of the stars, then we should hardly be surprised that we both inherit and create that ineffable essence that lends meaning to eternity.

What is beautiful will not last; what we love will die away.

Yet, for all death’s power, the things that always mattered most are the things it cannot take away.

Tyler Johnson is inpatient oncology teaching service director at Stanford Hospital and a clinical assistant professor at Stanford.

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