My grandmother died a twentieth-century cancer death. Arijit Guha died in the twenty-first century. I watched him die on Facebook. She was eighty-four. He was thirty-two. I went to college with Arijit in Minnesota, and we knew each other but not well. After college, when I was already living in New York and in graduate school, I had dinner once with Arijit and my good friend Sarah. I was friends with her, and he was friends with her, and so there the three of us landed. Arijit and Sarah were both vegetarians, and we went to a veggie Thai place in the East Village. We had a table by the window. Arijit sat facing me, and I sat looking out past him and onto First Avenue at the cars driving north in a rhythm dictated by a traffic light I couldn’t see. I didn’t know that within four years both Arijit and Sarah would be dead. Arijit worked in scientific publishing. Arijit was interested in science, policy, and the environment. Arijit was thinking about graduate school himself. I liked him and wished I had known him better, but I knew I probably never would.
Arijit was diagnosed with stage IV colon cancer when he was a grad student in Arizona. He was twenty-nine. He called his blog Stage IV Hope. He came home from India, where his family is from, with stomach problems. But they never went away. His colon contained a growth, 6 centimeters wide, his own cells, but different. Their story is his story, or at least the end. Mutated. Growing unchecked. One of his cells came loose, lost itself, lucked into a mistake, a mutation, that allowed it to divide and divide and divide and never die. Our cells, except those for reproduction and those used to regenerate other cells, are made not to divide and divide and divide and never die. That is cancer, really: a cell, your cell, a part of you, that forgets the whole and grows and divides itself. Selfish. In Arijit, that cell, himself but different, became a threat to the rest, to his organism, to his life. It would reroute resources to itself, alter its metabolism to grow and grow and grow. It would mutate again because cancer cells get so sloppy with their DNA, and isn’t that the point. One cell that would become two and then four and then eight and eventually would be a massive clump of cells, thousands, hundreds of thousands, each individual invisible to the eye but now a visible growth, a tumor, that you could hold in your hands if only you could cut him open wide enough. And they would cut him open wide enough. Arijit died in 2013. My grandmother wouldn’t die until the following year. She died in the twentieth century. She never wrote about her cancer on Facebook or on Twitter.
The eusocial insects include organisms from three separate orders: Isoptera (termites); Homoptera (aphids); and Hymenoptera (ants, wasps, bees). These species form highly ordered social structures and organize their communities to differentiate between reproductive and nonreproductive roles. There is a queen, and sometimes more than one; there are workers. The social structure can be maintained only because the hive or brood is interrelated. It must be so in order to avoid cheaters, selfish individuals who will act in their own interests, propagate, and overtake the whole. Because reproduction is limited to one (or a few) individual(s), all members of the brood are siblings (or closely related). In some species of ants, the queen can reproduce asexually; then, all individuals in the hive are clones of one another.
Although it remains a point of controversy in the field, there has long been the hypothesis that ant colonies form a superorganism: that individuals in the colony act much like single cells in a multicellular organism. An organism like you or me. Certainly, eusocial insects, like ants, break the typical laws of evolution. According to evolutionary theory, individuals ought to be selfish. Survival of the fittest. The one who propagates the most wins. In ant colonies, workers give up their rights to reproduce for the better of the whole. But why? Group selection (where the individuals in the colony compete not with each other but with other colonies for resources)? Kin selection (because each ant is a copy or a sister to the others)? Most researchers agree that the hive is a body, and the body is all that matters: that it moves, that it eats, that it thinks, grows or shrinks, touches on the ground and touches, too, the sky.
The last time I saw Arijit—Thai food, First Avenue—I was studying bacteria and the viruses that infect them. I didn’t start studying cancer until after he got sick. I had no academic interest in cancer. When I was in graduate school, a friend was working in a cancer biology lab. She was doing something like taking cancerous cells from patients, taking healthy cells from the same patients, purifying all the RNA from those cells (the messages from our genes that get turned on and off) to identify profiles unique to cancer. She was seeking the signature of impending death. My mind can’t make sense of this type of science. It’s too messy to me: thousands of genes up or down with no good way to know which matter.
I preferred studying the behavior of one protein: how it turns itself on or turns itself off. I needed simplicity.
I asked her why she would study such a thing. She said something about how her grandmother died of cancer. My grandmother was even then dying of cancer. I was callous. How many grandmothers and grandfathers, old already, died of cancer, and all that our new therapies are giving them is two or three more painful months of life before they die. The drugs cost millions to make, for two extra, painful months. How many young people around the world die of infectious diseases that don’t get any research funding because none of our grandmothers or grandfathers died of malaria or TB? Plus who cares about disease? I just want to understand how stuff works. She got quiet. I had said too much.
I never imagined myself a cancer researcher. In fact, I still don’t. When I finished graduate school, I wanted to stay in New York, and I wanted to do work that I liked. A friend was starting a new lab. The lab would be in New York. He was working on DNA replication, the process through which cells copy their DNA with each division. Mistakes made in this process are mutations. Mutations cause cancer. That is the simplest version of this complicated story. We would be studying this machinery, as simple as cancer research can be. Just some proteins working together. Just some proteins turning on, turning off. Mostly, the job was in New York, and the work was interesting, and so I became, against my will, a cancer researcher.
I work in yeast. Yeast use the same tools to copy their DNA as humans. They grow quickly and can be modified with relative ease. They do not get cancer. Yeast are simple. I’m taking the DNA replication machinery apart to map how the proteins work together. I am studying how mutations arise, like the one in a luminal epithelial cell in my grandmother’s left breast in 1973, a mutation that could have killed her then, a mutation that participated in her slow death for all the years that I knew her. Like the mutation in a cell in Arijit’s colon, a mutation that would allow a cell to divide, two cells now, and divide again, now four, and grow and grow, making ever more mutations until that one cell, himself but different, would take over his body. His own cell, that one cell, would win, first a mass of cells and then a tumor and then writing the end of his too-short life even before his body felt ill, even when everything was fine, even when Arijit was just another twentysomething living just another life.
An ant colony may have one queen or more than one, but typically she will make only one journey out of the nest. The queen, the key to reproduction, is valuable. Necessary for the colony. So she stays close to home. All her energy given over only to making more workers. On her one trip out of the hive, she will collect sperm. She mates only once (her nuptial flight, poetically named), but will collect enough sperm to produce offspring for years (twenty-five or more). She keeps the sperm alive and swimming that long. She keeps herself alive that long too. The colony will survive her death. Her eggs may remain unfertilized, in which case her offspring will be male. Males have wings, they are not workers. They will fly and reproduce on the nuptial flight. Then they die. Fertilized eggs become females—workers or queens, but usually workers. A humble worker, yes, who can lift five thousand times her own weight. Any worker could be a queen, and I suppose any queen a worker. In most species the queen is larger than the workers and will sprout wings to carry her body to mate that one time or to fly off, maybe one day, to start a new colony. She’s in service to the workers, bearing the burden of reproduction. The workers are in service to her, finding nourishment, feeding her endlessly, carrying away her waste. They are all—the queens, the workers, even the males with their short lives and programmed deaths—in service to the collective, the colony. It’s all determined, laid out at birth. There’s no escape. There’s nothing but service, and service only to the whole, the collective, the colony. There is no chance of a part of the colony growing and growing and growing, a hostile takeover, the end of their story written from within.
They would cut Arijit open wide, his insides spilling out, his insides still growing. His doctors wanted to cut it out, but his cells had spread. He had growths covering his abdomen. Taking him over. Eating him alive. His prognosis was grim but not without hope. Ten percent five-year survival. Could be worse. Arijit quickly maxed out his graduate student insurance plan. All those chemo sessions (thousands and thousands each to save his life, maybe). Arijit had done everything right except to get sick. He was in school. He was young. Still, he had insurance. And yet, and yet. Within a year of his diagnosis, Arijit and his wife had two options: debt or death. His memorial tree planted at Carleton College—our alma mater—describes him as a “do-gooder, rabble-rouser, mustache enthusiast, streaking aficionado.”
He would choose debt, but Arijit did not go quietly into his decision. He fundraised, as weak as he was, with the help of his wife, with the help of his friends, many of them from Carleton. It was quintessential Arijit Guja: his theme was Poop Strong, and they sold T-shirts boldly emblazoned with the motto “KEEP CALM AND POOP STRONG” and a cartoon of a colon. His cancer went viral. He raised hundreds of thousands of dollars.
And Twitter almost saved him. Arijit was waiting for the Affordable Care Act to kick in so he could buy insurance even though he had a hell of a preexisting condition. I watched this all on Facebook, often sitting at a desk in a lab where I was not yet studying cancer. Arijit did not wait quietly. His cells were eating him from the inside, fighting a battle against himself. His cells were dividing, putting their needs above that of his whole. He would not be quiet, sit and sleep, recover. No, no. He didn’t have the time. When the CEO of his health insurance company, the company with its lifetime student insurance cap, Tweeted about their stunning profits, he Tweeted back. Arijit’s Tweet: “@Aetna’s 4th qtr profit up 73%: ‘it continued to benefit from low use of health care.’ Helps they can ensure low use.” (Arijit’s words in bold.)
On PoopStrong.com you could buy Poop Strong T-shirts, mugs, baby onesies, tote bags, plastic bracelets. He was the low use. He paid for his insurance, but his uniquely high cost as a consumer was kept low, five-figure chemotherapy sessions notwithstanding. Twitter allowed him access across layers of bureaucracy that were previously impenetrable. His one Tweet reached directly to the top. He called out a lie, and publicly. Within twenty-four hours he was on the phone with the CEO of his insurance company. His bills would be paid. He could concentrate on his health. And indeed he would later Tweet the word remission and take a hopeful break from chemo altogether. Poop Strong would give away much of the money they raised, an astonishing amount of money, to charity, to cancer research. To people like me doing work like the work I am now doing. Arijit appreciated his good luck but claimed to newspapers, to friends, to anyone who would listen, that fixing one case, his, did not fix a deeply broken system. Not everyone can Tweet their way well.
Ant colonies can grow and grow and grow and grow. Single colonies that cover a square mile: we’ve known about that for decades. Hundreds of millions of workers all working. Over a million queens. All reproducing. Working and reproducing and eating and feeding and removing waste, and digging, digging, digging. To date, the largest recorded ant colony stretches thousands of miles across southern Europe. Yes, thousands of miles. All of Europe colonized by ants from South America. There seems to be a small justice in that. Billions of workers. Millions of nests and so millions of queens. And no aggression between workers, everything harmonious, only aggression toward outsider ants, ants that don’t belong, ants who could take over. One superorganism stretched over hills and mountains, stretched over time zones, stretched wide, but one, stretched thin, but one. Queens and workers and males working in harmony over thousands of miles: building, building, building, digging, digging, digging, eating and feeding, reproducing and even dying, but only a worker, only one queen, and never, not ever, the nest, the colony.
In the end, not even Arijit could Tweet his cancer away. Like Susan Sontag who wrote about cancer when she was dying or not dying of it herself, Arijit wrote his illness down. Sontag wrote a book. Arijit’s death was written online and in real time. Arijit wrote on Twitter, on Facebook. Sontag wrote, “Illness is the night-side of life, a more onerous citizenship. Everyone who is born holds dual citizenship, in the kingdom of the well and in the kingdom of the sick.” Arijit held both passports in his hand, as, I suppose, do I. His is a twenty-first-century cancer story. One that ends the same way as twentieth-century cancer stories: with death. Arijit died. He left his wife a widow. He died before his mother or father. His own cells grew too large for his body. His own cells grew large even as they made his body thin, too thin. He looked starved to death at the end, his photos on Facebook terrifying and sad and beautiful. Beautiful because he laughed in spite of it. Beautiful because even in his pain, he never lost himself or his sense of humor. Beautiful because he was clearly still so strong in spirit, in love, even as his body was failing or fading away. In one picture he smiled from a hospital bed holding a sign that said “Fuck Cancer!” I wanted to hug him. It looked like a hug might have hurt him. Arijit died, a half-assed mustache on his face, and I wanted him not to be gone, even though he was never really near me in the first place.
Ants don’t abide by cheaters. For example, a new colony will grow faster and survive longer, be in better competition with neighboring colonies, if it initially has several queens. But later, it may be more advantageous to have a single queen, the one with the highest fecundity, the best ability to make her offspring, her workers. Then, the workers will eat the other queens alive, will destroy them so the collective can be as prosperous as possible. And how will they pick which queen is best? The chemicals, of course, that she secretes. It would be so simple for a selfish queen to cheat, to evolve to secrete the right chemicals to survive while she knows good and well that she’s not the best queen around. But it doesn’t happen. Researchers couldn’t find a single example. The queens are honest, and then they die so that the collective can not only live on but also prosper. They’re but a cell in the superorganism. Their death is meaningless, like the programmed death of your cells or mine while we’re still drowning in the womb. The colony remains a sparkling pillar of efficiency, digging deep into the safety of the earth, building tunnels up to the food and light, spreading out by feet and then by yards and then by miles because among them not one queen and not one worker is selfish. And so the world is theirs.
Life and death become real only when your people start to die. Not your grandparents. No. They can be mourned, missed. My grandma died of cancer. But that is life’s course. Not even your parents’ loss can make death real. There is nothing quite like losing your mother, the one who gave you life, the one who was there to offer you love when everyone else had given up. But that is life’s course: losing first your grandparents and then your parents before getting old yourself, before dying.
Life and death become real only when your people start to die. Can life be real before you begin to take the possibility of one death, your own, seriously? Only there do we learn the stakes. Writer Maggie Nelson said she met her own death only through the abject pain of childbirth: “If all goes well, the baby will make it out and so will you. Nonetheless, you will have touched death along the way. You will have realized that death will do you in too, without fail and without mercy.” For Audre Lorde, it was her own cancer that made her consider her mortality: “I was going to die, if not sooner then later, whether or not I had ever spoken myself.” Both Nelson and I hide behind the second person; only Lorde confronts her own death and names it as such. Life and death become real when you get sick, when you have children, when your people start to die. You will have touched death along the way. I was going to die. Everyone who is born holds dual citizenship.
It’s not about the intimacy of my loss. My grandmother is much closer to me than Arijit Guha. He was just a boy I barely knew. But his death, the loss of him, made my own body vulnerable. Oh sure, I knew it was vulnerable, my body. I was never that arrogant teenager who drove recklessly, who did drugs and drank. An invincibility complex, my mom called it. But I had never considered my own extermination, either. Arijit’s body was killed by his body. He died. It was no accident. He couldn’t keep his own cells in check, and they grew, they divided, took over his abdomen first, the rest of him later. They were selfish, his cells, and when his organism could no longer check them, he died.
I hold both passports in my hand: the sick and the well, both. I will die. Not just my grandmother, and not even my mother, but me. Me me me. My cells too may grow selfish. Even now, within me, one or more may be lying in wait. Mutating, changing, myself but different, ready to take on the rest. The very thing I study in the lab. Ant colonies can be so long-lived that we don’t know how old their superorganisms grow to be. It’s not that I want to live forever, but I don’t want to die. My own cells may learn to divide divide divide. The humble ant queen keeps her workers in check, or rather they do that for themselves, and they check her too. I will never spread myself out over thousands of miles. My right index finger in Portugal, my left pinky in Italy. I won’t ever lift five thousand times my own body weight. My grandmother died. It’s not that I want to live forever. Arijit died. When part of me dies, the rest goes with it. I will die and no queen can replace me. Not in this body. My own cells, too selfish. My own cells, my own story, this story, writing itself even now, and writing too its end.