I.
To have cancer is to take an unasked-for trip inside the body, to be forced to see by the stark light of day the body’s normally invisible workings. It is to see the self (or a part of the self) lit up on an ultrasound screen, a black mass nestled in the grainy gray flesh of your breast, and know—not in a passing way, but in a fateful, here-to-stay way—that’s me. And then you dive in even deeper and understand that the mass exists because of a disorder in your house at the cellular level.
Like rude party guests, your cells have ceased to behave. They do not wait for the proper signal from the host to invite more friends, but multiply with raucous abandon, overrunning the house. They (unlike the rule-abiding hosts) are not bothered by overcrowding. Normal cells are governed by a principle called “contact inhibition”: they sense the presence of other cells in the room, and when the room gets too crowded, they politely stop dividing. Cancer cells don’t respond to these chemical cues. They fill the rooms to bursting, spilling out the windows, passing out drunk in the back yard.
To know that your life depends on a microscopic dollop of protoplasm and its antics is to see life in a whole new way. The more you think about the complex mechanics of cells and the body, the trillions of tiny signals and movements and chemical shufflings that undergird a single second of a living body’s existence, the more improbable your own existence seems. It is a cliché that grave illness and brushes with death tend to heighten humans’ sensitivity to the numinous: illness brings us closer to God, or at the very least to a chastened understanding of “what really matters” in life. This is because illness is a radically decentering experience, revealing the self as dependent on some larger unseen thing that humbles by its sheer complexity and magnitude. Call it biological life; the earth’s ecosystem; the cosmos; God.
To think of what must happen at a cellular level to allow me each morning to twist my hair into a bun, apply a shade of age-appropriate lipstick, grab my keys and coffee, and head out the door—to glimpse the vast, mysterious architecture that enables and gives its blessing to that self—is to recognize the almost comical contingency of any single life. It is to realize how little in possession of our lives we actually are, how little they belong to us.
II.
We secular moderns are ill equipped to deal with this decentering, to make sense of our individual lives as embedded in a larger whole (whether biological or theological). But for millennia, the self was unintelligible outside of its participation in the cosmos. From ancient Greece up through early modern Western thought, the human body was imagined as a microcosm, replicating in miniature the structure of the universe. No motion of the stars or planets was without its corollary motion in the world of earthly creatures below.
Before it was a disease, cancer—from the Greek karkinos, or crab—was a constellation. Babylonian astronomers, who identified it as early as the second millennium BC as one of a dozen-plus star patterns, used its movements across the night sky to divine the future. The Greeks gave the Babylonian crab a back story: as Heracles was fighting off the Hydra in one of his 12 labors, Hera sent a giant crab to wrestle him and slow his progress. Heracles, undaunted, crushed the creature easily with his heel. Hera collected the shards of the crab’s body and placed them in the night sky, a reward for the poor beast’s loyalty.
By the second century A.D., Ptolemy had codified the predictive art of star reading in his Tetrabiblos, or Four Books of the Influence of the Stars. Ptolemy refined the notion of the universe as a series of 10 revolving nested spheres, containing the sun, moon, planets, and stars of the zodiac, with Earth as its fixed center. The Earth itself and everything on it, including the human body, were composed of four elements—earth, water, fire, and air—that in order and balance mirrored the motions of the heavens. Because human, animal, plant, and mineral bodies were created from the same material as astral bodies, they necessarily exerted an influence on one another, creating a web of secret sympathies and correspondences that bound the universe together.
That the sun’s motions should influence earthly bodies was evident enough. But the positioning of the moon, planets, stars, and zodiac clusters, though their action might be less directly visible, also affected the wax and wane of Earth’s creatures. And Ptolemy wrote that “all the [heavenly bodies’] various influences compounded together,” once expertly measured and calculated by the astrologer, could help predict “the destiny and disposition of every human being.” This was especially true in matters of health in later centuries, as the four humors composing the human body—blood, phlegm, black bile, and yellow bile—were thought to rise and fall, like the ocean’s tides, in response to the distant tug of celestial motions. When the humors in a body became unbalanced, blocked, or thickened, sickness ensued.
Early modern physicians consulted astronomical tables when treating patients. Medical almanacs contained charts for calculating the moon’s position as it cycled through the signs of the zodiac, as well as tracking which planet was dominant at each hour of the day and night. When the moon was in its first and third stages, the body’s liquids were thought to cluster at the surface of the body like tidal waters, making that a propitious time for bloodletting to drain off polluting humors. To aid in treatment, medical almanacs frequently included an anatomical illustration of the human body, Homo signorum, nicknamed by historians Zodiac Man.
Zodiac Man stares out impassively at the viewer in one jewel-colored version, a map of the heavens superimposed on his patient, outstretched body. The figure stands atop two fish representing Pisces, while Leo the lion fills the heart and chest cavity, and a muscled Taurus sits coiled around his shoulders: to each body part, its corresponding star cluster. The moon was thought, like a cosmic magnifying glass, to intensify the power of each zodiac sign, so that the brief period of their crossing each month was sure to signal a critical phase in any associated ailment. The careful practitioner who sought to cure a patient of headaches knew, for example, not to undertake bloodletting when the moon was in Aries, the constellation responsible for sicknesses of the head.
Once the blood was drawn, the physician carefully examined it for texture, color, smell, and even taste, as a means to further gauge the nature of a patient’s illness. Greasy blood indicated that the liver was failing to concoct ingested food properly, and an herbal elixir—gathered and compounded when the heavens were propitiously aligned—might help to right the organ’s function. Robert Turner’s 1664 plant encyclopedia lists native English plants and their healing virtues. White maudlyn, a sweet garden herb under the sway of fiery Jupiter, helped stimulate “cold and weak livers.” Water betony, ruled by cold Saturn, acted as a “good cooler in Burnings and Scaldings,” and a paste made of sheep’s dung, hog lard, and leaves of betony mashed in a mortar was “likewise good to dissolve swellings and hard knobs.”
Marsilio Ficino’s 1489 Three Books on Life gives useful tips on how to augment the body’s vitality through medical astrology. “If you want your body … to receive power from some member of the cosmos, say from the Sun,” he counsels, “seek the things which above all are most Solar among metals and gems, still more among plants, and more yet among animals, especially human beings.” Some of the created things with which contact could boost the solar composition of the body: gold, chrysolite, amber, saffron, aloeswood, hawks, swans, and people with blond hair. “The above-mentioned things can be adapted partly to foods, partly to ointments and fumigations, partly to usages and habits,” Ficino advises. If you think your liver is failing to do its appointed work of heating the ingested contents of your belly, “draw the power of the liver to the belly both by rubbing and by fomentations made from things which agree with the liver,” such as chicory, endive, and pastes concocted from animal livers.
So it was that nothing in the created universe existed in and of and for itself. Leaf and stone, bird and beast, planet and human were not strangers one to the other but secret sharers, speakers of a common cosmic tongue. So it was that the physician, at his patient’s side, could taste the stars in a drop of blood.
III.
The English word zodiac is derived from the Greek zoidiakos kyklos, meaning circle of little animals. Early modern illustrations of the zodiac look like aerial views of a carousel: a menagerie of sign-creatures—lion, bull, scorpion, fish—wrapped around a sphere. The year that I lived in Florence with my family, on Sunday afternoons in the fall we’d go to the park and hope that the carousel was open. The crispness in the air and the setting November sun were melancholy, so to catch a glimpse of the wheeling carousel, with its string of bright white lights and tinsel music, was like swallowing something warm—a tonic against the encroaching frost, a draught of heat to counterbalance the chill in our cheeks and fingers. My four-year-old would hoist herself up on some slick, colorful beast, and I’d take a seat in one of the gilded coaches painted with curlicues and flowers, my one-year-old perched on my lap, and round we’d go.
Today, as cancer cycles through my body, the memory feels like a talisman, part charm, part warning: tiny spinning animals, earthbound specks of light beneath the darkling sky.
IV.
The hospital where I get my chemo infusions is brand spanking new, bright and white and cheerful in these pre-Covid times. This is encouraging. If my body is bent under the weight of its sickness, the building at least is upright, seemingly immune to the battering of the elements and the wear and tear of time. I grab my café au lait from the kiosk in front of the hospital. The automatic glass doors part before me, and, from behind a modishly curved white desk at the entrance, a young woman smiles expansively and wishes me welcome. I feel as though I could be at a bank or a hotel, which, I suppose, is the point. The modern Western biomedical enterprise is designed to put nature, red in tooth and claw, to rout. That most obscene and inhumane of natural outcomes, death, is an enemy not to be tolerated. We see this in the military vocabulary commonly used to describe cancer treatment itself: it is a “battle,” always “valiantly fought,” and the patient who “beats” cancer in this zero-sum game is reckoned a “survivor”: humans 1, nature 0.
The blood-draw station on the ground floor is my first stop. I wait for the nurse to call my number—0756—then take a seat in the phlebotomist’s chair. First the squeak of the rubber strap as she knots it around my bicep, then “make a fist.” I wait for what I know will come next. “Good veins,” she murmurs from behind her surgical mask, and I feel a blush of idiot pride, as I always do: gold foil star for anatomy. My siphoned blood is whisked offstage for testing, and a specialist trained in the modern art of blood reading will decipher my fate. “Your numbers look good, Ellen,” my oncologist, who appears to be no older than 18, will later assure me.
At the blood-draw station, they play ambient music on a loop, the kind that mixes synthesizer panpipes with recorded nature soundscapes: trickling water or wind or birdcalls, sometimes all three. It is music I’ve heard only in yoga classes or in the massage rooms at boutique spas; it makes me think of warm towels and the sweet smoke of incense. An MRI imaging study, I learn, shows that the brain relaxes its fight-or-flight response when exposed to nature sounds, even recordings of them. Still, I find the music incongruous as I look out at the other patients in the waiting room. We are so many scattered atoms, shuttled one by one through this clean, white biomedical machine. What have we to do with wind and water and birdsong, the bosomy embrace of nature?
After I’m cleared by my oncologist, I head up to the fourth floor and check in. The waiting room crowd here is a little more haggard than that down below: an older man in faded jeans coughs from behind his white protective face mask; a woman in a flowered headscarf pages through People magazine. This level is for the Truly Ill, the transplant and cancer patients. My nurse Michael comes out to get me. He is tousled-blond and chipper, tall and broad shouldered, with gym-perfected pecs and biceps that swell to fill his red scrubs. We chat about small things as he preps my medicines. Did I try the Tylenol and Claritin mix the doctor recommended for postchemo bone pain? Yes, I say, and it doesn’t do a damn thing; only Advil helps a little. Michael nods vigorously in agreement. “I’m an Advil fan too,” he confesses. As he slides the IV needle into my arm, he apologizes with a wince, mirror neurons at work. “Liiiittle pinch, I’m so sorry.”
In the infusion room, each patient gets her own mini-cabin, discreetly partitioned. We sit side by side, as if in a movie theater, facing floor-to-ceiling windows that run the length of the building. We each have our own private room with a view. This is a university hospital, and across the street they are building a new dormitory for medical students. Beyond the construction is a train track, then the 101 freeway, and beyond that the dusty green foothills of the San Gabriel Mountains. Hawks circle above the palm trees, searching out snakes and mice and rabbits and baby birds, as humans scuttle about on the sidewalks below, noses buried in their phones.
We no longer see the earth as part of us, an entanglement of heart and sinew, bound by the shared tempo of circling blood and circling planets. Rather, we exist in uneasy cohabitation with nature, each carving out its own separate sphere. Nature is ingenious and tries to adapt to our incursions. The hawk learns to hunt and pick across an urban landscape, gorging on human-fed songbirds, a fattened luxury unknown in the wild. It learns to nest in eucalyptus trees, good in a pinch when more hospitable native trees are scarce. As for humans, we take nature in medicinal doses, and always on our own terms, packaged into easily digested health supplements.
V.
In the vegetable kingdom, few plants are more toxic to humans than Taxus baccata, the European yew tree. Ingesting even a handful of its evergreen needles can be lethal. They contain compounds, known as taxines, that inhibit calcium and sodium transport in myocardial cells, leading to arrhythmia and then heart failure.
The yew is one of two plant ingredients that the witches in Macbeth throw into their maleficent brew: to accompany “root of hemlock digg’d i’ the dark,” they add “slips of yew, / Silver’d in the moon’s eclipse.” The animal ingredients the witches harvest for their potion sound even more monstrous to the modern ear. “Fillet of a fenny snake, / In the cauldron boil and bake; / Eye of newt and toe of frog, / Wool of bat and tongue of dog.” When Macbeth asks the witches to riddle his future, we are not surprised that his luck turns bad.
But many of these baleful-sounding ingredients would have had a familiar ring to the early modern ear. Herbs and minerals and animal parts were essential to concocting all manner of health-inducing pills, oils, and ointments. Edward Topsell’s 1658 History of Four-Footed Beasts and Serpents recommends, among “the medicines arising out of the female goat,” that “the right eye of a green living Lizard, being taken out, and his head forthwith struck off, and put in a goat’s skin, is of great force against … Agues,” and that a freshly killed adder, “included in a pot with the scrapings of Vines, and therein burnt to ashes,” makes an effective paste for soothing boils.
Indeed, so thin was the line separating the medical from the black arts that Robert Turner’s herbal manual begins by praising God for enduing “the Plants and Grass of the Field with such salubrious Faculties for our health and preservation” but then quickly turns to warn against their improper use. He speaks ominously of “druids,” “heathens,” “Medean hags and sorcerers” who forgo the lawful use of God’s creatures and, instead, “out of some Diabolical intention, search after the more Magical and occult Vertues of Herbs and Plants to accomplish some wicked end.”
There was sinister, demonic magic at work in the witches’ brew. But the protoscientific healing arts, freely mixing alchemy, astronomy, and botany, were magic, too, christened “natural magic.” Healers worked by trial and error to find the exact combination of herbs and stones and animal parts that would seal the rent in the universe that was a sickly, unbalanced body. The empirical sciences of the 17th century arose not in opposition to natural magic but as its outgrowth. They had their source not in the arid air-castles dreamed up by university philosophers but in the earth-caked grit of the apothecary’s lab.
I know about the Janus-faced yew tree, balm or bane depending on its use. Chemists in the 1960s isolated a molecule in yew bark and needles—resulting in paclitaxel, related to but distinct from the lethal compound taxine B—that prevents cell division in tumors. To divide, cells need to be supple and soft, able to split like a hunk of bread dough twisted into two smaller knots. Paclitaxel stiffens the cells’ molecular spines; when they go to divide, they splinter apart instead, scattered into lifeless pieces like Hera’s crushed crab. Trademarked and lab-produced as Taxol, this tree serum is one of the chemical concoctions that I receive, intravenously, every three weeks.
I have always been bad at numbers. In 11th-grade chemistry, I sat next to another mathematical dunce, a shy, sandy-haired girl named Tina, with whom the teacher paired me up to solve the equations he’d chalked out on the board. “Maybe between the two of you, you’ll come up with half the answer,” he’d quip. Today, with my unpracticed chemist’s eye, I scrutinize the formulas for poison (C33H45NO8) and salve (C47H51NO14) respectively; I trace the clusters of their rings and bonds, circles and dashes, with my finger. The skeletal formulae look like miniature constellations, printed in black and white. One arrangement of atoms stops the heart. But scramble the order, add or subtract an electron, and it stalls a tumor. This is a species of combinatory sorcery, mystery at the heart of matter.
After Michael hooks me up, I sit nodding beneath my chemo IV tree, a sac of Taxol hanging from its metal branches like a swollen plastic fruit. I imagine the matter-rich, earthy origins of this elixir—the roughness of scraped brown tree bark and crushed needles, boiled and baked into a clear quintessence—and suddenly, the self-enclosed loop of my body splits open like a vein and floods into the larger wheel of natural life, mixing my blood with its blood, a universal tumble and whirl, the stars in my cells. Slips of yew circling through my tissues, carrying out their chemical magic in the blind heart of my flesh, binding and unbinding, ever-shifting atoms blooming into momentary constellations that (with a dash of luck) will right my body’s wobbly universe, at least for a time.
