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Every breath we draw wards off
the death that constantly impinges on
us ... Ultimately death must triumph,
for by birth it has already
become our lot and it plays with its
prey only for a short while before
swallowing it up. However, we continue
our life with great interest and
much solicitude as long as possible,
just as we blow out a soap-bubble as
long and as large as possible, although
with the perfect certainty that it will
burst.

Chapter One

Julius knew the life-and-death homilies as well as anyone. He agreedwith the Stoics, who said, "As soon as we are born we begin to die,"and with Epicurus, who reasoned, "Where I am, death is not andwhere death is, I am not. Hence why fear death?" As a physician anda psychiatrist, he had murmured these very consolations into the earsof the dying.

Though he believed these somber reflections to be useful to hispatients, he never considered that they might have anything to dowith him. That is, until a terrible moment four weeks earlier whichforever changed his life.

The moment occurred during his annual routine physical examination.His internist, Herb Katz -- an old friend and medical schoolclassmate -- had just completed his examination and, as always, toldJulius to dress and come to his office for a debriefing.

Herb sat at his desk, rifling through Julius's chart. "On the whole, you look pretty good for an ugly sixty-five-year-old man. Prostate isgetting a little swollen, but so is mine. Blood chemistries, cholesterol,and lipid levels are well-behaved -- the meds and your diet are doingtheir job. Here's the prescription for your Lipitor, which, along withyour jogging, has lowered your cholesterol enough. So you can giveyourself a break: eat an egg once in a while. I eat two for breakfastevery Sunday. And here's the prescription for your synthyroid. I'mraising the dose a bit. Your thyroid gland is slowly closing down -- thegood thyroid cells are dying and being replaced by fibrotic material.Perfectly benign condition, as you know. Happens to us all; I'm onthyroid meds myself.

"Yes, Julius, no part of us escapes the destiny of aging. Along withyour thyroid, your knee cartilage is wearing out, your hair follicles aredying, and your upper lumbar disks are not what they used to be.What's more, your skin integrity is obviously deteriorating: yourepithelial cells are just plain wearing out -- look at all those senile keratoseson your cheeks, those brown flat lesions." He held up a smallmirror for Julius to inspect himself. "Must be a dozen more on yousince I last saw you. How much time you spending in the sun? Areyou wearing a broad-brimmed hat like I suggested? I want you to seea dermatologist about them. Bob King's good. He's just in the nextbuilding. Here's his number. Know him?"

Julius nodded.

"He can burn off the unseemly ones with a drop of liquid nitrogen.I had him remove several of mine last month. No big deal -- takes five, ten, minutes. A lot of internists are doing it themselvesnow. Also there's one I want him to look at on your back: you can'tsee it; it's just under the lateral part of your right scapula. It looks differentfrom the others -- pigmented unevenly and the borders aren'tsharp. Probably nothing, but let's have him check it. Okay, buddy?"

"Probably nothing, but let's have him check it." Julius heard thestrain and forced casualness in Herb's voice. But, let there be no mistake,the phrase "pigmented differently and borders aren't sharp,"spoken by one doc to another, was a cause for alarm. It was code forpotential melanoma, and now, in retrospect, Julius identified thatphrase, that singular moment, as the point when carefree life endedand death, his heretofore invisible enemy, materialized in all its awful reality. Death had come to stay, it never again left his side, andall the horrors that followed were predictable postscripts.

Bob King had been a patient of Julius's years ago, as had a significantnumber of San Francisco physicians. Julius had reigned over thepsychiatric community for thirty years. In his position as professor ofpsychiatry at the University of California he had trained scores of studentsand, five years before, had been president of the American PsychiatricAssociation.

His reputation? The no-bullshit doctor's doctor. A therapist of lastresort, a canny wizard willing to do anything he had to do to help hispatient. And that was the reason why, ten years earlier, Bob King hadconsulted Julius for treatment of his long-standing addiction to Vicodan(the physician-addict's drug of choice because it is so easily accessible).At that time King was in serious trouble. His Vicodan needs haddramatically increased: his marriage was in jeopardy, his practice wassuffering, and he had to drug himself to sleep every night.

Bob tried to enter therapy, but all doors were closed for him.Every therapist he consulted insisted that he enter an impaired physicianrecovery program, a plan which Bob resisted because he wasloath to compromise his privacy by attending therapy groups withother physician-addicts. The therapists wouldn't budge. If theytreated a practicing addicted physician without using the officialrecovery program, they would place themselves at risk of punitiveaction by the medical board or of personal litigation (if, for example,the patient made an error of judgment in clinical work).

As a last resort before quitting his practice and taking a leave ofabsence to be treated anonymously in another city, he appealed to Julius,who accepted the risk and trusted Bob King to withdraw on his own fromVicodan. And, though therapy was difficult, as it always is with addicts,Julius treated Bob for the next three years without the help of a recoveryprogram ...

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Excerpted from The Schopenhauer Cure by Irvin D. Yalom
All rights reserved by the original copyright owners. Excerpts are provided for display purposes only and may not be reproduced, reprinted or distributed without the written permission of the publisher.