When I started reporting this story, just as Jason had risen from his deathbed, his cancer miraculously gone, I thought I might be writing a book about the quest for immortality. The journey of the immunologists was reaching a point at which we could resurrect people. As a species, led by an international cadre of brilliant scientists, we were discovering how to tinker with the immune system, such that we could prolong life for who knew how long.
It was the first question I began asking: Are we looking at living a long, long time? How can I not wonder? Is this about immortality?
It’s absolutely fair to say that the journey to extend life has been a defining characteristic of the human condition.
If the quest has been immortality, we are miserable failures. Yes, we’re living longer, and better, but the best we’ve got to show for it is the occasional person who hits a hundred and ten. It’s a blip. Now I understand one of the key reasons. Our immune system is doing us in.
You heard right. The defense network—so often upheld as the key to health, and it is that, certainly—plays a big part in the way Jason’s story ended, and in how all of our stories will end.
The underlying reason for this particular meaning of life comes from several key aspects of the immune system—attributes that I’ve laid out over the course of this book.
One has to do with the trade-offs that the immune system is constantly making to keep things balanced in the Festival of Life. Take, for example, wound healing. The immune system has to allow our cells to divide so that we can rebuild after injury. The immune system fosters new cell development, helps access blood and nutrients, lets the festival thrive. But this trade-off also allows for the strong possibility—even inevitability—that malignant cells will thrive.
“Cancer happens in everyone,” Dr. Jacques Miller, who a lifetime ago discovered the role of the thymus, told me as we discussed the meaning of the immune system and life. The brain will fail, the organs will shut down, the lungs will flood. Some of these will owe to breakdown of our defenses, some to an overwhelming pathogen, but some, like cancer, will arise from a complicity of the immune system itself.
The reason is that the immune system hasn’t evolved to defend us as individuals. It has evolved to defend our genetic material and the species as a whole. It does an extraordinary job of keeping us alive until we reproduce and then rear our offspring. After that, it does an even better job of moving us out of the way.
“Evolution has decreed we cannot live forever,” Dr. Miller said. “Nature, evolution, has decreed you’ve got to make way for the next generation.”
Ruslan Medzhitov, the Yale scholar whose pioneering work illuminated the innate immune system, echoed this thought and added a point that no medicinal fix we contrive will lead us to live forever. “There is no ultimate solution. There is no free lunch. If you cure cancer, you will have more cases of neurodegenerative disease. If you cure neurodegenerative disease, a major plague will come for people who are a hundred years old. There is no ultimate solution, nor should there be.”
But this reality is blessed with light. “We have to distinguish between life-span and health-span,” Medzhitov said. “You don’t want to live forever, but you do want to be healthy when you’re old.”
This is what all these inventions and innovations have provided us: a bit more life and a whole lot more comfort as we age. Less pain, anxiety, disabling disease. Less fragility.
As a species, we have strived for immortality and attained only a distant second place. But third place sucked a lot, earlier death, agony.
The Meaning of Jason holds two competing principles in exquisite balance: We must continue to strive, dream, and exercise all the passions that have gotten us this far, while also doing a much better job of accepting death. Death is not just inevitable, not just programmed into us and facilitated in ways by our immune system. It is essential for our survival.
It is not an easy leap to at once be driven by terror of death and yet embrace it with humility and grace. Our continued health lies in creating this balance, as elegant as the balance struck by the immune system itself.
On January 1, 2017, I was back in Colorado, loading the family into the car after a ski day, when my cell phone rang. I figured I’d let it go to voice mail. Big flakes floated down, and I was harried. But the caller was Guy Greenstein, Jason’s brother, and I just had this strange feeling.
“Hey, Guy.”
“Hey, Matt. I have some bad news. My mom died.”
Guy had found their mother collapsed outside of her bathroom. It looked like it had been the heart, and fast.
“The coroner, Mike, he said to me: Didn’t I just see you?”
Rest in peace, Catherine Greenstein.
Six months later, I lost my beloved grandmother, Anne Richtel, just a few days shy of her hundredth birthday.
In October of 2017, Ron Glaser went into hospice in the memory care unit. He became confined to a wheelchair because of the risk of falling. He understood little.
“I can put my face literally two inches from his, and he will look through me,” Jan Kiecolt-Glaser told me. In her particular spirit, she managed to find the glitter. “There are still golden moments when he recognizes me and smiles.”
Two months later, almost a year to the day that Cathy died, Dr. Ben Barres, the guru of dementia and the immune system, passed away on December 27, 2017. He was sixty-three. He’d hoped, he told me, to have an immunotherapy reprieve like Jason. He did leave a monstrous legacy that may yet spare us some of dementia’s cruel ignominy. He embodied proof of the value of diversity. Born a woman, he became a man and experienced the world through different eyes, perhaps allowing him to see what others could not.
During this project, death came and went. This, as I say, is not the place I expected to end up. I thought I’d tell the story of Jason driving in the foul-smelling Windstar to Denver to get his injection, waking up one morning to hear his girlfriend say his tumors disappeared, and then going on to another adventure. I thought he’d populate the world with yarns and fumes, pausing only briefly to fuel up at 7-Eleven for more snacks. In that survival story, I imagined, would be hope for all of us.
Not infrequently, after Jason’s death, and well before, I began to think of him in a new, and particular, light. I saw him as a son—the son who lost his father. This perspective is excruciating for me because my own son, Milo, is ten. Like Jason, he’s a jock—Prodigy 2 is what Jason called him. I’m Milo’s coach, just like Jason’s dad coached him. Like Jason and his dad, Milo and I are thick as thieves. Just like most fathers and sons. My daughter, Mirabel, is eight, a creative, funny, loving soul; a child of such magnificence, as is her brother. I dared not dream of having such offspring and somehow did. The prospective horror of leaving behind a son and daughter, a family, or losing one, has become palpable. Like so many, I count my blessings every day. Each day, I count with a little more gratitude. We have a finite time in this Festival of Life. It is beautiful. It hurts.
Thanks to science and wisdom both, we possess more comfort as we age, and knowledge about how our bodies work so as to make better choices. When sickness hits, we will get another year, or two or ten. The Argonauts have given us the miracle of extra days, and when my time is nigh, I’ll thankfully gulp every extra minute.
But I’ve also come to see a different reason for hope. The gifts given to us from human learning have come through extraordinary cooperation, through hard-earned and lucky experimentation—in labs, yes, but also in homes and statehouses, and in the “two steps forward, one step back” of cultural, political, social, and scientific advance. We won’t skirt inevitable death, not as individuals. However, when we pull back the lens, the Festival of Life can rage on if we find harmony as a species. Maybe, when it comes to it, I will have been able to give my son and daughter tools to carry with them and bring us all a molecule closer to peace.
After Jason died, I stood at the base of his bed and thanked him for always being kind to the little guy. Depending on the setting, each of us can find ourselves as the little guy or the top dog, as needing or being able to give, as supplicant, friend, bully, or antagonist. Each of us, like microscopic bit players in a larger organism, also has an outsized power to signal cooperation, find harmony, to hasten hostilities or dampen them.
The deep friendship I wound up forming with Jason captures a searing truth instructed by the immune system. We are in this together.