When Milton's Satan stood in the pit of hell and raged at heaven, he was merely a trifle miffed compared to how I felt on that day. I felt totally alone, with the world receding away from me in every direction, and you could have used my anger to weld steel. Only my family and the fact I had fans in the medical profession, who were able to give me useful advice, got me through that moment.

I went through some really terrible times. I don’t know whether I should really even mention it, but you mentioned that I had to go to prison and all that stuff. I was in a state where they had me in a straitjacket at one time. Can you understand what it would feel like to be in a straitjacket? I know. I couldn’t either, but I was, and it was brought about by sort of a drug psychosis in prison. I mean I just went completely… But it was tough, it was tough. I mean at that time they put you in — there’s a place in New York they used to call the Tombs. You’ve probably heard of it. I mean it was like a living tomb, with all the people. So I was there, and the withdrawal — physical symptoms, which were unbelievable.

And in the end they robbed us, but they did let us go. But I think that that was a very useful lesson early in my journalism career, that things can go very badly wrong. At one moment you can be going down a road and things are perfect, and the next moment you’ve got some drunk soldiers who just may kill you. That fear that I felt when they were holding us for maybe 45 minutes or so in the jungle, that has never entirely left me.

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.

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.

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.”

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.

Myself, I love the imagery of struggle. I sometimes wish I were suffering in a good cause, or risking my life for the good of others, instead of just being a gravely endangered patient. Allow me to inform you, though, that when you sit in a room with a set of other finalists, and kindly people bring a huge transparent bag of poison and plug it into your arm, and you either read or don’t read a book while the venom sack gradually empties itself into your system, the image of the ardent soldier or revolutionary is the very last one that will occur to you. You feel swamped with passivity and impotence: dissolving in powerlessness like a sugar lump in water.

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.

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.