I’ve had a plethora of new readers to this blog. As I’ve examined where they are focusing, many of them are reading things I’ve written about my cancer, multiple myeloma, or suffering in general. I am presently working on a book, How Cancer Taught Me to Swear, which is more than a memoir, but a deconstruction of many of our cultural and especially religious views of cancer and suffering. I am going to pull some excerpts from that rough draft. This excerpt below is from chapter ten, where I discuss the why of multiple myeloma.

Chapter Ten, Digging Out

Those who imagine a God, a spiritual force, or even the cold, dark universe as intentional and deterministic, as expressed in the statement, “All things happen for a reason,” find great comfort when things are going well. Marx was right in this situation when he wrote in his 1844 work, A Contribution to the Critique of Hegel’s Philosophy of Right,  “Die Religion… ist das Opium des Volkes,” which of course means, “Religion can be the opiate of the masses.” But when disaster strikes, such a presupposition creates a personal dilemma. The only comfort in that place is to recognize that there is space within the boundaries of reality for simple cause and effect and meaningless randomness; otherwise, like it or not, your God becomes the devil. To try to hold in the clutches of the same hand, a good God who controls everything, and pure evil, pushes one into delusional thinking that is unsustainable. Maybe I am wrong, and some people, maybe even you, can imagine a God that loves them and deliberately gives them hell on earth.

If I were to explain the whole story of how my healthy body developed multiple myeloma, it would take a book larger than this one. The human body is far more complex than most people realize, and the most astute scientists cannot fully appreciate.

We have a type of white blood cell called B lymphocytes that lives primarily in the bone marrow. We have around 300 billion of these cells in our bodies, and their primary function is to make antibodies to fight infections. Approximately 20 billion of them differentiate into one of two types of plasma cells: transient ones that live for days to weeks, or permanent ones that last for years or even a lifetime.

Like all cells, plasma cells have a nucleus that contains the blueprint for all body structure and functions, which, of course, is DNA. Surrounding the cell’s nucleus is the cytoplasm. Photocopies of that blueprint, called messenger RNA (mRNA), carry that information from the nucleus into the construction site in the cytoplasm. Rough Endoplasmic Reticulum (RER) and other cytoplasmic machinery will follow the instructions on the blueprint photocopies to make various widgets the cell needs. While virtually all cells have this mechanized production system, plasma cells have optimized their production to pump out large quantities of a single widget: the antibody.

Following the mRNA instructions, amino acids are bolted together by the ribosome and folded into the correct shape by the RER. Each plasma cell has selected five different heavy-chain options and one of the two light-chain options, lambda or kappa, to make a complete antibody. After each of these chains is independently folded into the correct shape in the RER,  two identical heavy chains and two identical light chains are fastened together, almost like braiding hair, to form a single antibody. If the production isn’t synchronized, there can be extra light chain parts that don’t get assembled into complete antibodies. The antibody, along with any leftover or “free” light chain proteins, is released into the bloodstream. The free light chain proteins are eventually excreted by the kidneys. Each plasma cell produces thousands of these antibodies per second. A bustling factory!

All cancers begin with a mutation in a cell’s DNA, and multiple myeloma is no different. A toxin, radiation, or genetic cause may account for this mutation, but most of the time it is due to an unknown reason, likely a simple accident in the copying process. In multiple myeloma, there are typically at least two mutational steps. In the first step, the mutation causes cells that are not supposed to reproduce to start cloning themselves. When this happens, the unique antibodies produced by these cloned plasma cells are detected on a Serum Protein Electrophoresis, which separates proteins by type, as an “M-spike.” These clonal cells may mutate again, at a rate of about 1% chance per year, turning into cells that proliferate wildly. This, my friends, is multiple myeloma.

The first problem with multiple myeloma is that these proliferating cells take over the bone marrow, crowding out healthy tissue that makes blood cells and protects us from infections. Overwhelming infections are the leading cause of death in multiple myeloma. Sometimes I wish I could better convince some of my friends and family of this risk, like a friend who intentionally coughed on me during the COVID pandemic to mock me for wearing a mask, or well-meaning family members who took me to a very crowded restaurant, although I had told them I couldn’t go there. An infection would have been the death of me at that time.

The next problem is that the proliferation of these clonal plasma cells is so great that the bone marrow can’t contain them, and they start to erode the bones from the inside out. They do this by activating old bone resorption and inhibiting new bone formation. Fractures are often the first symptom of multiple myeloma. If, like with the victim I mentioned, whose first symptom was fracturing her neck and becoming a quadriplegic, it can be deadly.

While half of multiple myeloma patients have kidney damage, in only five percent of us is it severe. This happens because the proliferating cancerous plasma cells produce far more light-chain proteins, either lambda or kappa, than can be braided with the heavy proteins, and they leave the plasma cell as “free light chains” that gum up the kidneys. The kidneys are meant to process unbound, free light-chain proteins, but not when their levels are 1,000 or 10,000 times normal.

B cells are one of the few cell types that edit their own DNA sequences. They do this to create new antibody genes. Every day, over a billion new B cells need to make multiple cuts and joinings of their DNA to make a unique antibody. This happens tens of trillions of times throughout a person’s lifetime. If instead of connecting the high-powered antibody production gene to a new antibody piece, the DNA editing mechanism mistakenly connects the high-powered antibody production machinery to a cell-growth gene, then later, when the cell becomes a mature plasma cell, instead of turning on antibody production up to full power, it will instead turn growth up to full power. This exact DNA swap is observed in most multiple myeloma cells, in which the antibody gene is fused to one of a handful of growth genes.

One way to look at it is to imagine that each typed word is equivalent to one gene. However, a gene contains much more information than a single word. If you were to type 150 quadrillion words nonstop, it would take you almost five hundred million years—without stopping to pee—to finish, typing sixty words per minute. And each keystroke must be perfect.

I have written books with one million keystrokes. With three or four layers of proofreading by myself and others, it is still hard not to have one mistake, one wrong keystroke in the manuscript. Therefore, rather than being angry at my body for the errors, I am overwhelmed with gratitude for the precision that keeps all of us alive. We walk tightropes of glass.

Specifically, for me, the typo in my DNA during the transition of one B lymphocyte to a plasma cell was that the long (q) arm of chromosome 1 was enhanced or longer than it should be, the long (q) arms of chromosomes 9, 5, and  15, were shorten or missing, and in another chromosome location, 14q32, some extra genetic material had leaked in. Just five typing errors in quadrillions of copies. Understanding this mechanism for cancer prevented me from asking the question, “Why me?” which implies some meaning for cancer. But understanding the incredible way our bodies work, and I’ve only written about plasma cells, the baseline of our existence is a miracle every second. Disease is the lack of a miracle for one millisecond, when an error sneaks in.

To an atheist, a natural evolutionist, this makes perfect sense. From their perspective, we came into being by chance, and natural selection made us who we are. Natural selection depends on DNA mistakes. Dr. Jianzhi ZhangIt published a paper in Nature in 2022 that estimated that over 75% of those mistakes have a detrimental outcome, 1.3% have an adaptive or positive benefit, and the rest are neutral. But the only positive benefit from a naturalistic evolutionary perspective is reproduction.

Because there is a much higher rate of cancer in our older, non-reproductive ages, natural selection has no interest in overcoming the disease. As a matter of fact, if you are honest about it, the death of older people has an advantage, at least biologically. By thinning the herd of the infertile, you would have more resources for the fertile. Maybe, indirectly, having grandparents around increases the odds of grandchildren maturing to their reproductive ages, but that’s a stretch. Natural selection is only interested in reproduction, such as extending women’s fertile years, and research has shown that this has been happening over the last 60 years. If suffering, depression, and misery caused us to be more fertile, reproducing more offspring, then natural selection would work to make us more so. But atheism has its own problems, as I’ve mentioned, not the least of these are the fine-tuning of the cosmos for human life and the loss of a personal consciousness, meaning, and morals.

A theistic perspective faces its own difficulties when confronted with tragedy. We have only a few logical conclusions. God created the cosmos and the profoundly complex systems of biology and physics, but either God can’t control the mistakes within those systems or doesn’t want to. If God can’t control the mistakes, God is incompetent, much like the gods of the Greco-Roman world. Those weak gods, who were as much victims of fate as we are, were not viable. The much more competent monotheistic God supplanted them. A God who does control fate… and mistakes. But this competent God raises the question: are they good if they willingly allow suffering?

For me, the only logical answer to a God who is big enough and good is that, for reasons we can’t understand, a real mystery, nature is allowed to take its course most of the time. I am not a deist, because deists believe God never intervenes.

Five of the first six American presidents were deists, as well as other statesmen such as Ben Franklin. This was the only way they could hold on to a mighty God who allows mistakes. But I still pray… and boy do I pray… always hoping for an intervention from God. While an honest observation of life, I know that God rarely intervenes in the cause-and-effect of nature, but the hope of God’s intervention springs eternal.

Unfortunately, as I have alluded to, it is a widespread belief to project meaning into tragedy. It must have happened for a reason… right? God did it for my good? I believe we have to let go of that notion to find peace. “Shit happens” is a profoundly healthy theological position. I don’t know why Christians have such a hard time with that concept, as the idea of a fallen, dangerous, imperfect cosmos is one of the cornerstone teachings of the faith.

Most of the great theologians in Christian history knew that God wasn’t the author of evil or mistakes. This includes Augustine, Thomas Aquinas (my favorite), and even John Calvin. Calvin was the most deterministic of them all but still wrote that God did not create things like cancer, yet God allows such disasters for a reason. But by God selectively allowing tragedies, we are back to the same problem of cancer having a purpose. Yet, to be clear, even though I don’t believe cancer is intentional, part of God’s plan, I do think we have options as to what we do about it. Withdraw into a cave of self-pity? Fight the monster with all we have? Encourage other sufferers to fight as you do? Fund research that is looking for cures? The ESPN sportscaster, Stuart Scott, who had a long battle with a rare appendix cancer, used to say, “I can fight cancer without fighting God.” C.S. Lewis expressed similar views in his books, The Problem of Pain, and A Grief Observed.

There are local reasons, cause-and-effect, for everything, but not universal reasons. My neighbor, Jean, whom I mentioned in chapter three, who died in a car wreck, had a local reason. She had just learned her boyfriend was breaking up with her, and she was furious. She jumped behind the wheel of her parents’ car and drove fast down a winding road to reach him before he left for college. She passed a vehicle on the double yellow line, driven by extreme emotion. She hit an oncoming car at high speeds. There is a reason, as there is a reason for cancer, but the meaning stops at the local level rather than the celestial.

Because I had learned that shit happens and for no celestial reason in 1990, as my religious world was collapsing, I did not have to doubt God in 2019 when I developed cancer. For those who maintain the need for meaning in their tragedy, I believe, will eventually feel unloved by God in their secret places.

Speaking of secret places, those dark books we all have in our hearts, that, as Dickens wrote, are shut with a spring, I want to pull the cover of my book open to let just a little light in on my greatest enemy in my fight for recovery.

 Since leaving evangelicalism, I have never felt unloved by God. Neither had I ever felt unloved by the first person to love me, my mother. And maybe to my disadvantage, she was the first to teach me a language of love. But no one else in my experience has loved like her, not in that native language of love she spoke. One could argue that she overcompensated for her own unfamiliarity with parental love, losing her mother to cancer, and the aftermath. She told me, over and over, that she loved me every day and that I was wonderful. But that is not how the real world works, is it?

I hesitate to be more candid, for, as the Police will tell you, “What you say can and will be used against you.” I had a good religious friend once, and I told him a little about my struggles in the past with anxiety. From that day forward, he criticized me and tried to define everything I did or said as my “mental illness.” It was unbearable, and when I tried to stop his attacking me, he would say it was my mental illness that made me unable to take his criticism. Maybe before I had cancer, I could have put up with his pious condemnations, but not after.