The night before brain surgery, I thought about death. I searched out my larger values, and I asked myself, if I was going to die, did I want to do it fighting and clawing or in peaceful surrender? What sort of character did I hope to show? Was I content with myself and what I had done with my life so far? I decided that I was essentially a good person, although I could have been better--but at the same time I understood that the cancer didn't care.I asked myself what I believed. I had never prayed a lot. I hoped hard, I wished hard, but I didn't pray. I had developed a certain distrust of organized religion growing up, but I felt I had the capacity to be a spiritual person, and to hold some fervent beliefs. Quite simply, I believed I had a responsibility to be a good person, and that meant fair, honest, hardworking, and honorable. If I did that, if I was good to my family, true to my friends, if I gave back to my community or to some cause, if I wasn't a liar, a cheat, or a thief, then I believed that should be enough. At the end of the day, if there was indeed some Body or presence standing there to judge me, I hoped I would be judged on whether I had lived a true life, not on whether I believed in a certain book, or whether I'd been baptized. If there was indeed a God at the end of my days, I hoped he didn't say, 'But you were never a Christian, so you're going the other way from heaven.' If so, I was going to reply, 'You know what? You're right. Fine.'I believed, too, in the doctors and the medicine and the surgeries--I believed in that. I believed in them. A person like Dr. Einhorn [his oncologist], that's someone to believe in, I thought, a person with the mind to develop an experimental treatment 20 years ago that now could save my life. I believed in the hard currency of his intelligence and his research.Beyond that, I had no idea where to draw the line between spiritual belief and science. But I knew this much: I believed in belief, for its own shining sake. To believe in the face of utter hopelessness, every article of evidence to the contrary, to ignore apparent catastrophe--what other choice was there? We do it every day, I realized. We are so much stronger than we imagine, and belief is one of the most valiant and long-lived human characteristics. To believe, when all along we humans know that nothing can cure the briefness of this life, that there is no remedy for our basic mortality, that is a form of bravery.To continue believing in yourself, believing in the doctors, believing in the treatment, believing in whatever I chose to believe in, that was the most important thing, I decided. It had to be.Without belief, we would be left with nothing but an overwhelming doom, every single day. And it will beat you. I didn't fully see, until the cancer, how we fight every day against the creeping negatives of the world, how we struggle daily against the slow lapping of cynicism. Dispiritedness and disappointment, these were the real perils of life, not some sudden illness or cataclysmic millennium doomsday. I knew now why people fear cancer: because it is a slow and inevitable death, it is the very definition of cynicism and loss of spirit.So, I believed.

Tell me something. Do you believe in God?'Snow darted an apprehensive glance in my direction. 'What? Who still believes nowadays?''It isn't that simple. I don't mean the traditional God of Earth religion. I'm no expert in the history of religions, and perhaps this is nothing new--do you happen to know if there was ever a belief in an...imperfect God?''What do you mean by imperfect?' Snow frowned. 'In a way all the gods of the old religions were imperfect, considered that their attributes were amplified human ones. The God of the Old Testament, for instance, required humble submission and sacrifices, and and was jealous of other gods. The Greek gods had fits of sulks and family quarrels, and they were just as imperfect as mortals...''No,' I interrupted. 'I'm not thinking of a god whose imperfection arises out of the candor of his human creators, but one whose imperfection represents his essential characteristic: a god limited in his omniscience and power, fallible, incapable of foreseeing the consequences of his acts, and creating things that lead to horror. He is a...sick god, whose ambitions exceed his powers and who does not realize it at first. A god who has created clocks, but not the time they measure. He has created systems or mechanisms that serves specific ends but have now overstepped and betrayed them. And he has created eternity, which was to have measured his power, and which measures his unending defeat.'Snow hesitated, but his attitude no longer showed any of the wary reserve of recent weeks:'There was Manicheanism...''Nothing at all to do with the principles of Good and Evil,' I broke in immediately. 'This god has no existence outside of matter. He would like to free himself from matter, but he cannot...'Snow pondered for a while:'I don't know of any religion that answers your description. That kind of religion has never been...necessary. If i understand you, and I'm afraid I do, what you have in mind is an evolving god, who develops in the course of time, grows, and keeps increasing in power while remaining aware of his powerlessness. For your god, the divine condition is a situation without a goal. And understanding that, he despairs. But isn't this despairing god of yours mankind, Kelvin? Is it man you are talking about, and that is a fallacy, not just philosophically but also mystically speaking.'I kept on:'No, it's nothing to do with man. man may correspond to my provisional definition from some point of view, but that is because the definition has a lot of gaps. Man does not create gods, in spite of appearances. The times, the age, impose them on him. Man can serve is age or rebel against it, but the target of his cooperation or rebellion comes to him from outside. If there was only a since human being in existence, he would apparently be able to attempt the experiment of creating his own goals in complete freedom--apparently, because a man not brought up among other human beings cannot become a man. And the being--the being I have in mind--cannot exist in the plural, you see? ...Perhaps he has already been born somewhere, in some corner of the galaxy, and soon he will have some childish enthusiasm that will set him putting out one star and lighting another. We will notice him after a while...''We already have,' Snow said sarcastically. 'Novas and supernovas. According to you they are candles on his altar.''If you're going to take what I say literally...'...Snow asked abruptly:'What gave you this idea of an imperfect god?''I don't know. It seems quite feasible to me. That is the only god I could imagine believing in, a god whose passion is not a redemption, who saves nothing, fulfills no purpose--a god who simply is.

The other day as I was stepping out of Star Grocery on Claremont Avenue with some pork ribs under my arm, the Berkeley sky cloudless, a smell of jasmine in the air, a car driving by with its window rolled down, trailing a sweet ache of the Allman Brothers' "Melissa," it struck me that in order to have reached only the midpoint of my life I will need to live to be 92. That's pretty old. If you live to be ninety-two, you've done well for yourself. I'd like to be optimistic, and I try to take care of my health, but none of my grandparents even made it past 76, three killed by cancer, one by Parkinson's disease. If I live no longer than any of them did, I have at most thirty years left, which puts me around sixty percent of the way through my time.I am comfortable with the idea of mortality, or at least I always have been, up until now. I never felt the need to believe in heaven or an afterlife. It has been decades since I stopped believing-a belief that was never more than fitful and self-serving to begin with-in the possibility of reincarnation of the soul. I'm not totally certain where I stand on the whole "soul" question. Though I certainly feel as if I possess one, I'm inclined to disbelieve in its existence. I can live with that contradiction, as with the knowledge that my time is finite, and growing shorter by the day. It's just that lately, for the first time, that shortening has become perceptible. I can feel each tiny skyward lurch of the balloon as another bag of sand goes over the side of my basket.

He sank back into his black-and-white world, his immobile world of inanimate drawings that had been granted the secret of motion, his death-world with its hidden gift of life. But that life was a deeply ambiguous life, a conjurer's trick, a crafty illusion based on an accidental property of the retina, which retained an image for a fraction of a second after the image was no longer present. On this frail fact was erected the entire structure of the cinema, that colossal confidence game. The animated cartoon was a far more honest expression of the cinematic illusion than the so-called realistic film, because the cartoon reveled in its own illusory nature, exulted in the impossible--indeed it claimed the impossible as its own, exalted it as its own highest end, found in impossibility, in the negation of the actual, its profoundest reason for being. The animated cartoon was nothing but the poetry of the impossible--therein lay its exhilaration and its secret melancholy. For this willful violation of the actual, while it was an intoxicating release from the constriction of things, was at the same time nothing but a delusion, an attempt to outwit mortality. As such it was doomed to failure. And yet it was desperately important to smash through the constriction of the actual, to unhinge the universe and let the impossible stream in, because otherwise--well, otherwise the world was nothing but an editorial cartoon.

I sat wondering: Why is there always this deep shade of melancholy over the fields arid river banks, the sky and the sunshine of our country? And I came to the conclusion that it is because with us Nature is obviously the more important thing. The sky is free, the fields limitless; and the sun merges them into one blazing whole. In the midst of this, man seems so trivial. He comes and goes, like the ferry-boat, from this shore to the other; the babbling hum of his talk, the fitful echo of his song, is heard; the slight movement of his pursuit of his own petty desires is seen in the world's market-places: but how feeble, how temporary, how tragically meaningless it all seems amidst the immense aloofness of the Universe! The contrast between the beautiful, broad, unalloyed peace of Nature—calm, passive, silent, unfathomable,—and our own everyday worries—paltry, sorrow-laden, strife-tormented, puts me beside myself as I keep staring at the hazy, distant, blue line of trees which fringe the fields across the river. Where Nature is ever hidden, and cowers under mist and cloud, snow and darkness, there man feels himself master; he regards his desires, his works, as permanent; he wants to perpetuate them, he looks towards posterity, he raises monuments, he writes biographies; he even goes the length of erecting tombstones over the dead. So busy is he that he has not time to consider how many monuments crumble, how often names are forgotten!

The humanitarian philosophies that have been developed (sometimes under some religious banner and invariably in the face of religious opposition) are human inventions, as the name implies - and our species deserves the credit. I am a devout atheist - nothing else makes any sense to me and I must admit to being bewildered by those, who in the face of what appears so obvious, still believe in a mystical creator. However I can see that the promise of infinite immortality is a more palatable proposition than the absolute certainty of finite mortality which those of us who are subject to free thought (as opposed to free will) have to look forward to and many may not have the strength of character to accept it.Thus I am a supporter of Amnesty International, a humanist and an atheist. I believe in a secular, democratic society in which women and men have total equality, and individuals can pursue their lives as they wish, free of constraints - religious or otherwise. I feel that the difficult ethical and social problems which invariably arise must be solved, as best they can, by discussion and am opposed to the crude simplistic application of dogmatic rules invented in past millennia and ascribed to a plethora of mystical creators - or the latest invention; a single creator masquerading under a plethora of pseudonyms. Organisations which seek political influence by co-ordinated effort disturb me and thus I believe religious and related pressure groups which operate in this way are acting antidemocratically and should play no part in politics. I also have problems with those who preach racist and related ideologies which seem almost indistinguishable from nationalism, patriotism and religious conviction.

In 2008, the national Coping with Cancer project published a study showing that terminally ill cancer patients who were put on a mechanical ventilator, given electrical defibrillation or chest compressions, or admitted, near death, to intensive care had a substantially worse quality of life in their last week than those who received no such interventions. And, six months after their death, their caregivers were three times as likely to suffer major depression. Spending one’s final days in an I.C.U. because of terminal illness is for most people a kind of failure. You lie on a ventilator, your every organ shutting down, your mind teetering on delirium and permanently beyond realizing that you will never leave this borrowed, fluorescent place. The end comes with no chance for you to have said goodbye or “It’s O.K.” or “I’m sorry” or “I love you.”People have concerns besides simply prolonging their lives. Surveys of patients with terminal illness find that their top priorities include, in addition to avoiding suffering, being with family, having the touch of others, being mentally aware, and not becoming a burden to others. Our system of technological medical care has utterly failed to meet these needs, and the cost of this failure is measured in far more than dollars. The hard question we face, then, is not how we can afford this system’s expense. It is how we can build a health-care system that will actually help dying patients achieve what’s most important to them at the end of their lives.