You did not know what it meant, friend, when a lump started growing in your neck in college, but now, over a decade later, that node gnarled and dead, a new immune system churning in the pulp of your bones, you sit across the table from me wearing green scrubs, humble and bright. It’s a quiet night at the VA, and you and I are talking science – the hard stuff, your territory – and while I knew you were handy with a pipette, I did not know you could launch, off-the-cuff, into beautiful descriptions of modern cancer therapy. It’s microscopic warfare: let’s subdue this overzealous enzyme; let’s unleash a lymphocyte army; let’s enlist antibodies that sail, with great precision, toward their targets – and the more you talk, the more I lean forward, feeling very conscious of how (thanks to you) old pieces of knowledge, rusted from years of disuse, are flying together like magnets from remote corners of my mind and taking cohesive shape. Consider the average prostate cancer, you say, turning over a sheet of paper and sketching as you go – this was my favorite part of your monologue – it feeds on hormones, so shouldn't chemical castration starve it to death? Well, the cancer starves, to be sure, but no one expected the subsequent backlash: a cellular identity crisis! Sapped of its testosterone bath, that delicate prostate cancer may become confused and start to wonder, Am I even a prostate carcinoma anymore? Perhaps now I am a neuroendocrine tumor? and then proceed to experiment – dye its hair purple, for example, or start playing loud music in the basement. Sadly, these rebellious growths, deprived of their hormonal lifeblood by oncologists, are more vicious and resistant to therapy than ever before. Conundrum! But science keeps moving, doesn’t it, friend? It’s a stalling game; we whack the mole with our molecular mallets and wait for it to change positions and rise again. What new mallet will you build? How far could we go? Some speak of a Cure, and while I hate to talk about cancer that way (because cancer is so many different things), I sometimes dream up a cancerless world. Can you picture it now? What do you see? I see oceans of people with dementia, and the brain – oh man – that one might take a bit longer to figure out.

This post was written by Emily Silverman, MD. Along with Glitter and Two Deaths, it won second prize for Best Essay in the 2016 LitQuake Writing Contest.