And of course, I wonder why I was not more vigilant about checking my skin, because if I had been, I would have picked up that first melanoma before it turned bad, and saved myself a lot of heartache. When I was first diagnosed, I was angry with myself for being too lazy and stupid to bother with anything but the occasional quick examination. But then I decided that kind of thinking was a waste of my time, because we start dying the moment we are born. I know that now. The knowledge has changed from a first illuminating but soon forgotten premonition into an undeniable lived reality.

I was terribly upset at the time, because I felt I had betrayed [my wife] Kate and my family by being so stupid. But I’ve accepted it.

I have more than once in my time woken up feeling like death. But nothing prepared me for the early morning last June when I came to consciousness feeling as if I were actually shackled to my own corpse. The whole cave of my chest and thorax seemed to have been hollowed out and then refilled with slow-drying cement. I could faintly hear myself breathe but could not manage to inflate my lungs. My heart was beating either much too much or much too little. Any movement, however slight, required forethought and planning.

Deprivation of the ability to speak is more like an attack of impotence, or the amputation of part of the personality. To a great degree, in public and private, I “was” my voice. All the rituals and etiquette of conversation, from clearing the throat in preparation for the telling of an extremely long and taxing joke to (in younger days) trying to make my proposals more persuasive as I sank the tone by a strategic octave of shame, were innate and essential to me. I have never been able to sing, but I could once recite poetry and quote prose and was sometimes even asked to do so.

Before I was diagnosed with esophageal cancer a year and a half ago, I rather jauntily told the readers of my memoirs that when faced with extinction I wanted to be fully conscious and awake, in order to “do” death in the active and not the passive sense. And I do, still, try to nurture that little flame of curiosity and defiance: willing to play out the string to the end and wishing to be spared nothing that properly belongs to a life span. However, one thing that grave illness does is to make you examine familiar principles and seemingly reliable sayings. And there’s one that I find I am not saying with quite the same conviction as I once used to: In particular, I have slightly stopped issuing the announcement that “Whatever doesn’t kill me makes me stronger.”

My chief consolation in this year of living dyingly has been the presence of friends. I can’t eat or drink for pleasure anymore, so when they offer to come it’s only for the blessed chance to talk. Some of these comrades can easily fill a hall with paying customers avid to hear them: they are talkers with whom it’s a privilege just to keep up. Now at least I can do the listening for free. Can they come and see me? Yes, but only in a way. So now every day I go to a waiting room, and watch the awful news from Japan on cable TV (often closed-captioned, just to torture myself) and wait impatiently for a high dose of protons to be fired into my body at two-thirds the speed of light. What do I hope for? If not a cure, then a remission. And what do I want back? In the most beautiful apposition of two of the simplest words in our language: the freedom of speech.

The chief side effect of this pain is numbness in the extremities, filling me with the not irrational fear that I shall lose the ability to write. Without that ability, I feel sure in advance, my “will to live” would be hugely attenuated. I often grandly say that writing is not just my living and my livelihood but my very life, and it’s true. Almost like the threatened loss of my voice, which is currently being alleviated by some temporary injections into my vocal folds, I feel my personality and identity dissolving as I contemplate dead hands and the loss of the transmission belts that connect me to writing and thinking.

There is an even longer shot that I do propose to attempt even though its likely efficacy lies at the outer limits of probability. I am going to try to have my entire DNA “sequenced,” along with the genome of my tumor. ... So perhaps I will be able to contribute a little bit to enlarging the knowledge that will help future generations.