Dreams. Success

T

he dreams of my youth were simple. Someday I wanted to be like I already was but older. I sought a house to share with a beloved family and a job that I was good at. I wanted to be loved and respected and to feel that way about others in my life. In my young adulthood, my dreams veered ambitiously into specifics. Maybe I could be a doctor or better still, a doctor at a prestigious medical school. I could be promoted and even published in esteemed medical journals. It seems strange now, as cancer threatens my life at age 35, just how prescient my earlier dreams were and how seemingly less salient the latter ones have become. As I sit recovering from an intensive inpatient treatment called high-dose interleukin-2, pleading for my enhanced T cells to yield me a cure, it turns out that I am like a child once more. I only want to be like I am but older and surrounded by people I love and respect.

I think that sometime before my diagnosis, my dreams themselves began a kind of metastasis. They became increasingly aimed at bigger, shinier accomplishments, and when I had achieved those goals and notched those victories, the feeling of satisfaction was somehow less with each success. By the time I was being promoted and publishing, the glow from each achievement felt as fleeting as it was intoxicating. My aspirations had become a drug, and I needed more just to stay ahead of the fall. Perhaps many within academia can appreciate this plight.

When my diagnosis of advanced kidney cancer came in 2018, it changed how I viewed what I wanted to get out of this life and what I could give back to it. The prognosis in cases like mine are uncertain, leaving a lucky few to live for decades while some die very quickly. In a panic, I drew up an actual bucket list and started checking items off. I sat in the front row at a Mets game. I wrote a personal essay about my experience that I was invited to read on National Public Radio. I got myself nominated to be a Medical All-Star and was honored on the big screen at Fenway Park with my toddler in my arms. My wife and I drove a rented red Corvette down the New Hampshire coastline just because we could. If my life were a movie, this montage would be fantastic to watch.

Navigating down the bucket list also made me realize how empty this approach leaves a person and confirmed what I’ve learned from my practice in psychiatry: the reward is always in the journey, not the outcome. Once one achieves a fanciful dream, all that’s left is the memory and the void where it once existed. Pursuing life in this way leaves a person always wanting something just a little bigger and never fully realizing that the universe grows with us all the time. Its ends can never be reached.

As the high-dose interleukin-2 coursed through my veins last week, my body shook violently and suffered all manner of illness not fit for sharing. I knew it was coming and was well prepared. I had visitors come from within the very hospital where I work. My parents, brother, and wife took turns tending to me. I thought their primary job was to alert the staff if I began to hallucinate, one of the relatively common effects of this treatment. But the hallucinations I experienced were very minor—little transient glitches in vision, and nothing like the dancing monkeys I had been told to expect by previous patients.

Instead, their role was to remind me of what dreams are truly meaningful in this life. Much of the treatment is a blur now, but unlike the temporary highs of my bucket list, I will never stop feeling the weight of my father’s calming hand on my forehead as my body trembled through the worst of it. And I’ll never forget the sound of my son’s voice as he ran through the front hall to hug me upon my return.

The early recovery has gone well, except my sleep remains disrupted. In particular, my experience of actual nighttime dreams is altered. The treatment seems to have left me with a more acute sense of where my mind goes at night and an unnerving ability to remember it. My brain’s nightly travels are not to Harvard, The New York Times, or any other lofty ivory tower. My dreams—the actual content of my brain when I let go—take place almost entirely right here, in our little house with the ones I love most.

We won’t find out if this treatment has been effective for some time, but it has reminded me of something I already knew as a boy. The secret about achieving your dreams is to realize what matters to you as much when you were a child as when you are soaring among the clouds and when you just begin to fall.

Section Editor: Preeti Malani, MD, MSJ, Associate Editor.

<img src=”https://api.b2c.com/api/noscript-384qixmcp2s94lcpe6l.gif?journal=jama”&gt;

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Article Information

Corresponding Author: Adam Philip Stern, MD, Beth Israel Deaconess Medical Center and Harvard Medical School, 330 Brookline Ave, KS 178, Boston, MA 02215 (astern2@bidmc.harvard.edu).

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