But if I was sitting in an armchair with bits and pieces of rubber sticking out of me and my son came over and said, you know, would you like a banana? Wink once for yes, wink twice for no, I dont think the interest of the conversation would get me past the sense that this is horrible. It's horrible for me but above all, horrible for them. There are things worse than death.

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.

Yes, these are subjects that we think about all the time but don’t necessarily talk about. Everybody has thought about if they want to be cremated, buried, or whatever.

I’ve had a couple of ex-girlfriends sort of accuse me of having a personality disorder! … No, I don’t know. I’ve always been afraid of death. I’ve never wanted to die. Last year, I watched this guy die in Red Rock. It was this horrible freak accident thing. He fell and he cracked his head and basically just bled out. That was the first time I’d ever actually seen a climbing accident like that. It was kind of sobering — he was even wearing a helmet — it was a reminder of how dangerous climbing can be if things go wrong even when you have all the ropes on.

It was this celestial splendor that suddenly made me realize how little time, how little life, I had left. My sense of the heavens’ beauty, of eternity, was inseparably mixed for me with a sense of transience — and death. ... I told my friends Kate and Allen, “I would like to see such a sky again when I am dying.” “We’ll wheel you outside,” they said.

I feel a sudden clear focus and perspective. There is no time for anything inessential. I must focus on myself, my work and my friends. I shall no longer look at “NewsHour” every night. I shall no longer pay any attention to politics or arguments about global warming. This is not indifference but detachment — I still care deeply about the Middle East, about global warming, about growing inequality, but these are no longer my business; they belong to the future. I rejoice when I meet gifted young people — even the one who biopsied and diagnosed my metastases. I feel the future is in good hands.

My generation is on the way out, and each death I have felt as an abruption, a tearing away of part of myself. There will be no one like us when we are gone, but then there is no one like anyone else, ever. When people die, they cannot be replaced. They leave holes that cannot be filled, for it is the fate — the genetic and neural fate — of every human being to be a unique individual, to find his own path, to live his own life, to die his own death.

I’ve had this concern all the time, but I can only hope that if one writes with appreciation and delicacy and respect, then it’s okay. I have to say that I’ve written a hundred times as much as I’ve published, because if there’s any thought of offense or embarrassment, then I will put the thing quietly away.

And I spent four years at a boarding school in the country, probably a rather abusive boarding school, and seeing very little of my parents, and that was a very bad time for me. A bad and almost a mad time. ... I think that some sort of trust, and ability for closeness, may have been compromised. And I think I’ve perhaps, to some extent, sort of kept a distance since that time, although this is not a distance I feel with my patients or my students.

The peace of the Sabbath, of a stopped world, a time outside time, was palpable, infused everything, and I found myself drenched with a wistfulness, something akin to nostalgia, wondering what if: What if A and B and C had been different? What sort of person might I have been? What sort of a life might I have lived?