A few years ago, I was standing in a Christian cemetery with a Jewish friend.
“Do you believe in God?” he asked gently.
I gave him some spiel. College student stuff. “You know…sort of, man.”
For statistical reasons, he does believe in God. He explained to me the rational axioms of Pascal’s Wager (a theory that is significantly more disputable than the triangle of the same name.) It was published posthumously in Blaise Pascal’s Pensées. It goes like this:
Either God exists, or he does not. The choice to live your life believing in him is a game. If you play the game believing that he exists, you will either be rewarded for being right (Heaven,) or nothing will happen after you die (because he doesn’t exist.) If you play the game believing he does not exist, you will either be punished for being wrong (Hell,) or nothing will happen after you die (because he doesn’t exist; you were right.)
The C Word
Making Treatment Decisions
So, according to Pascal, you have four possible prospects for what happens after you die: Nothing, Nothing, Heaven, and Hell.
If you’re playing the game, you might as well believe. Heaven is the only good outcome. So try for that one.
Years later, Dr. Keith Cengel told me about what it’s like to hear you have cancer. He knows because he’s been on both sides of the chart. He got testicular cancer in his second year of medical school. Now he treats cancer. According to him, after you process the information, there are a few ways to cut it:
You can believe your treatment will go well. In this case, it either does or does not go well. If it does, you were right. Congratulations. If it doesn’t, you had time to feel hopeful, and you know you did everything you could.
You can also believe your treatment will not go well. In this case, you have the same two outcomes: it either does or does not go well. If it does, you were wrong, and you spent all that time worrying for nothing. If it doesn’t, you went through the whole hellish process without a speck of hope. And congratulations: you were right. You die with the satisfaction of being right (which is not a satisfying type of satisfaction. Because you die.)
Calling to mind the French philosopher who laid out this game, Dr. Cengel told me, “You might as well assume it’s gonna go well. Right? Because that’s a lot more fun.”
And that’s Dr. Keith Cengel.
It hardly needs saying, but he doesn’t just walk into work every day and roll the dice. He treats patients and coordinates research at the Cengel Laboratory, which works on the cutting edge of medical and radiation oncology to, as he put it, “push the bounds of the possible.” He remembers what it was like to hear he had cancer: “I felt lost about how to inform myself. And I had a PhD…patients need to know that this is challenging, and it’s okay that it is.” Dr. Cengel says that the internet has made everything much easier, but there are problems with the healthcare system (or lack thereof), and there still is not a widely institutionalized system of “patient navigation” to help smooth out the decision making process for the newly diagnosed. Everything is still confusing.
Yet the philosophy of chance drives him to keep beating cancer down. He compares it to pneumonia, which in 1930 had a sky-high death rate, and 30 years later was almost completely curable with antibiotics. Something could happen—something novel. We just have to keep trying, and keep believing it will go well. If we don’t believe it will go well, it won’t. Then we’ll be right. And as we know full well: with cancer, being right can be terrifying.