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. It took strenuous effort for me to cross the room of my New York hotel and summon the emergency services. They arrived with great dispatch and behaved with immense courtesy and professionalism. I had the time to wonder why they needed so many boots and helmets and so much heavy backup equipment, but now that I view the scene in retrospect I see it as a very gentle and firm deportation, taking me from the country of the well across the stark frontier that marks off the land of malady. Within a few hours, having had to do quite a lot of emergency work on my heart and my lungs, the physicians at this sad border post had shown me a few other postcards from the interior and told me that my immediate next stop would have to be with an oncologist. Some kind of shadow was throwing itself across the negatives.

The previous evening, I had been launching my latest book at a successful event in New Haven. The night of the terrible morning, I was supposed to go on The Daily Show with Jon Stewart and then appear at a sold-out event at the 92nd Street Y, on the Upper East Side, in conversation with Salman Rushdie. My very short-lived campaign of denial took this form: I would not cancel these appearances or let down my friends or miss the chance of selling a stack of books. I managed to pull off both gigs without anyone noticing anything amiss, though I did vomit two times, with an extraordinary combination of accuracy, neatness, violence, and profusion, just before each show. This is what citizens of the sick country do while they are still hopelessly clinging to their old domicile.

The new land is quite welcoming in its way. Everybody smiles encouragingly and there appears to be absolutely no racism. A generally egalitarian spirit prevails, and those who run the place have obviously got where they are on merit and hard work. As against that, the humor is a touch feeble and repetitive, there seems to be almost no talk of sex, and the cuisine is the worst of any destination I have ever visited. The country has a language of its own—a lingua franca that manages to be both dull and difficult and that contains names like ondansetron, for anti-nausea medication—as well as some unsettling gestures that require a bit of getting used to. For example, an official met for the first time may abruptly sink his fingers into your neck. That’s how I discovered that my cancer had spread to my lymph nodes, and that one of these deformed beauties—located on my right clavicle, or collarbone—was big enough to be seen and felt. It’s not at all good when your cancer is “palpable” from the outside. Especially when, as at this stage, they didn’t even know where the primary source was. Carcinoma works cunningly from the inside out. Detection and treatment often work more slowly and gropingly, from the outside in. Many needles were sunk into my clavicle area—“Tissue is the issue” being a hot slogan in the local Tumorville tongue—and I was told the biopsy results might take a week.

Working back from the cancer-ridden squamous cells that these first results disclosed, it took rather longer than that to discover the disagreeable truth. The word “metastasized” was the one in the report that first caught my eye, and ear. The alien had colonized a bit of my lung as well as quite a bit of my lymph node. And its original base of operations was located—had been located for quite some time—in my esophagus. My father had died, and very swiftly, too, of cancer of the esophagus. He was 79. I am 61. In whatever kind of a “race” life may be, I have very abruptly become a finalist.