The following text is adapted from a keynote address given to the recipients of the 2017 Whiting Awards for emerging writers.

When my mother’s mother began to die of a mysterious, undiagnosable neurological illness, the first thing she lost was her sense of taste. For most families, perhaps, this would be a rather inconsequential loss, but this had severe repercussions for us. As the matriarch of our heaving, multi-generational family, she had always helmed the kitchen with an efficient, if somewhat despotic, hand. Because all the food in that household was cooked by her—years earlier, an attempted takeover by one of the uncle’s wives had been swiftly and tyrannically rebuffed—my grandmother was, in fact, the ultimate arbiter of taste. For decades, this had been a relatively stable and blissful arrangement: she was an acutely talented cook. But as her taste buds numbed, week by week, the food turned from mild to well-seasoned to intolerably spicy. It was, perhaps, a kind of neural compensation for her—the way people with early hearing loss often begin to speak more loudly—but the fish curry now went off on the palate like a thermonuclear bomb. The lentils exfoliated the tongue. The fried spinach was an incinerating terror; the okra, an endurance sport. When even the white rice, the final refuge of the Asian tongue, began to arrive at the table with halved Thai bird peppers on top, the seeds squinting above it, we squirmed in terror. But we steeled ourselves and kept eating: numbness begetting numbness.

I want to talk to you today about desensitization. In my other life, I am an oncologist. Numbness, you might say, is my occupational hazard. Over the past month or so, I have watched twelve of my patients die from or relapse with cancer. Yesterday, I heard that a friend who ran my favorite restaurant, the place I went for daily refuge while I was writing my last book, passed away from tongue cancer that had colonized her brain and bones. When interviewers ask me how I carry on carrying on, I speak about the startling successes with some of my patients, about hope and the future. But I do not—I cannot—tell them that a certain kind of numbness must be a part of it. I come home from the bone-marrow-transplant wards on a January morning and play with my dog, rearrange the furniture, and practice polynomial factorization with my daughter. I celebrate a recent laboratory paper with a glass of champagne. I return to the wards the next morning and look down a microscope to find a marrow choked up with leukemia cells after a heroic attempt at salvage chemotherapy. And this cycle repeats. You might say that I have an advanced degree in desensitization.

But, of course, I am not here to describe the numbness that accompanies medical practice. There is a different form of desensitization that surrounds us today. When I was asked to give this talk to a roomful of aspiring writers, I had to confront the elephant-in-the-room question: How shall we continue to write in these numbing times?

On April 21, 1890, a thirty-year-old doctor turned writer named Anton Chekhov travelled to Sakhalin Island, a penal colony, in the Sea of Okhotsk, north of Japan. The journey took three months. To get to Sakhalin, Chekhov had to cross, by train, the wind-blown steppes of northern Russia and the still-frozen Siberian tundra. He boarded a horse-drawn carriage, then a steamer across the Amur River, and then a small trawler ship across the Okhotsk Sea.

Why, you might ask, did an unusually sensitive and mild-mannered man—delicate of physical and mental constitution—choose to travel to a hostile, faraway island inhabited by thieves, hustlers, and murderers? Chekhov told some of his friends that he was going to Sakhalin to run a census (and indeed he did run a census, although he didn’t seem to care particularly about the data). He told others that he was doing some sort of ethnographic project on the prisoners and settlers as part of his medical studies. But the census and the medical project were half-lies, each merely an excuse—a “device,” to use his word—to bring him to the island.

So what was the real reason that drove the journey? Chekhov’s medical training had left him spiritually depleted. He had honed his observational skills and matured into an astute diagnostician. But the extraordinary quality of suffering that he had witnessed, and the inscrutable arbitrariness of sickness and death, benumbed him. Much of this anguish would find eventual voice in his later works—particularly in the story “Ward No. 6”—but he wrote virtually nothing about it at the time. We also know that his health was declining. Chekhov’s brother had died, of tuberculosis, in 1889, a year prior to Chekhov’s departure, and Chekhov himself, having spit up blood just before the arduous journey, also knew that he was infected with the bacillus, and that the illness would likely kill him. Perhaps he thought that the island would offer a kind of medical or mental sanatorium.

But as much as he was encumbered by the diseased state of his body, Chekhov was repulsed by the diseased state around him—by the sickness of the body politic. “To a certain extent,” his biographer Ernest Simmons writes, “his anxieties mirrored those of all thinking people of the Eighties, this ‘epoch of social stagnation.’ ” Tsarist Russia in the eighteen-eighties was suffused with moral and economic depravity. It was a society overrun by corruption, bribery, and nepotism. Censorship abounded. The news was frequently manipulated and false. Political dissidents were kidnapped, assassinated, or packed off to prison. The élites ensconced themselves in grotesquely opulent homes while poverty, violence, illness, and incipient famine haunted parts of the land.

It wasn’t just disease or death that Chekhov was trying to escape; it was deadliness. “There is a sort of stagnation in my soul,” he wrote to a friend. Chekhov, then, was looking to resensitize himself—to un-numb the numbness. He sought a place where he might inoculate himself against the ennui that was slowly destroying his soul.

Sakhalin Island, to put it mildly, was not a place for the faint-hearted. What Chekhov found there was a community even more depraved than the one he had left behind—an island society on the edge of sanity, law, and self-discipline. The men on this island hunted each other for sport. Women were routinely sold into prostitution. The children were malnourished and enslaved by adults. The prisoners bribed the guards, and the guards beat the convicts nearly to death.

Two examples from Chekhov’s writings about Sakhalin Island serve as conduits or portals to a deeper point. One is an encounter on the ferry across the Amur River: