At the start of the year, in the weeks after I learned that I had cancer, I felt pretty well, despite my liver being half-occupied by metastases. When the cancer in my liver was treated in February by the injection of tiny beads into the hepatic arteries — a procedure called embolization — I felt awful for a couple of weeks but then super well, charged with physical and mental energy. (The metastases had almost all been wiped out by the embolization.) I had been given not a remission, but an intermission, a time to deepen friendships, to see patients, to write, and to travel back to my homeland, England. People could scarcely believe at this time that I had a terminal condition, and I could easily forget it myself.

This sense of health and energy started to decline as May moved into June, but I was able to celebrate my 82nd birthday in style. (Auden used to say that one should always celebrate one’s birthday, no matter how one felt.) But now, I have some nausea and loss of appetite; chills in the day, sweats at night; and, above all, a pervasive tiredness, with sudden exhaustion if I overdo things. I continue to swim daily, but more slowly now, as I am beginning to feel a little short of breath. I could deny it before, but I know I am ill now. A CT scan on July 7 confirmed that the metastases had not only regrown in my liver but had now spread beyond it as well.

I started a new sort of treatment — immunotherapy — last week. It is not without its hazards, but I hope it will give me a few more good months. But before beginning this, I wanted to have a little fun: a trip to North Carolina to see the wonderful lemur research center at Duke University. Lemurs are close to the ancestral stock from which all primates arose, and I am happy to think that one of my own ancestors, 50 million years ago, was a little tree-dwelling creature not so dissimilar to the lemurs of today. I love their leaping vitality, their inquisitive nature.

NEXT to the circle of lead on my table is the land of bismuth: naturally occurring bismuth from Australia; little limousine-shaped ingots of bismuth from a mine in Bolivia; bismuth slowly cooled from a melt to form beautiful iridescent crystals terraced like a Hopi village; and, in a nod to Euclid and the beauty of geometry, a cylinder and a sphere made of bismuth.

Bismuth is element 83. I do not think I will see my 83rd birthday, but I feel there is something hopeful, something encouraging, about having “83” around. Moreover, I have a soft spot for bismuth, a modest gray metal, often unregarded, ignored, even by metal lovers. My feeling as a doctor for the mistreated or marginalized extends into the inorganic world and finds a parallel in my feeling for bismuth.

I almost certainly will not see my polonium (84th) birthday, nor would I want any polonium around, with its intense, murderous radioactivity. But then, at the other end of my table — my periodic table — I have a beautifully machined piece of beryllium (element 4) to remind me of my childhood, and of how long ago my soon-to-end life began.