Where Is Max Ritvo’s Heaven?

On Tuesday, August 23rd, Max Ritvo died. He was just 25, but already famous for his poetry.

His notoriety came in part via a rare cancer, Ewing’s Sarcoma, that struck him at age 16. In the catastrophic diagnosis, Ritvo found focus; combining it with his enormous poetic prowess, he made powerful, sometimes transcendent work. In the nine years since his diagnosis—including several in remission—he’d earned a degree at Yale, then an MFA at Columbia; written a chapbook, Aeons; and then authored a poetry collection, Four Reincarnations, which will be released at the end of this month.

That book is likely to be good. Ritvo had written and spoken openly about his condition, especially since relapsing and being declared terminal in 2013, at age 22. The poems he’d already published are weighty, vivid accounts of his situation, yet so sensuously addictive that they often read like the printed equivalent of a dense, fancy dessert—a sort of poetic Death by Chocolate, emphasis on death.

In the end, his most striking poem might be distinctive not for the near-hallucinatory transcendence found in some of his other work, but that it seems to come from one ordinary corner of Max’s mind. Its insight into human smallness is a revelation—which, indirectly, connects cancer to war, and to trauma, and to the moon.

From one ordinary corner of Max’s mind, he wrote:

…They were to bargain for Heaven,
which is really just a hospital for souls.

When I get there, I will get there
and it will not be complicated…

I’m not that sick in Heaven.

*     *     *

There is a common trope that compares fighting life-threatening diseases to fighting wars. In her 1989 book AIDS and Its Metaphors, Susan Sontag suggested the idea has been around for as long as biomedical insight itself: “Modern medical thinking could be said to begin when military thinking becomes specific.”

Sontag, who died of leukemia in 2004, meant her book to describe not only acquired immunodeficiency syndrome, but also cancer. About both, she detailed “the way particularly dreaded diseases are envisaged as an alien ‘other,’ as enemies are in modern war,” and “how the body responds by its own military operations, such as the mobilizing of immunological ‘defenses,’ and medicine is ‘aggressive,’ as in the language of most chemotherapies.” She commented at length on how the “war” metaphor leads to victimization and stigma, but also said that, by imparting a sense of urgency, the idea has obvious appeal: “In all-out war, expenditure is all-out, unprudent—war being defined as an emergency in which no sacrifice is excessive.”

Sontag isn’t unique in this insight, of course. In 1969, for example, philanthropist Mary Lasker and fellow advocates pressed Richard Nixon to launch America’s “War on Cancer,” on the premise that cancer deaths were not only an urgent problem, but possible to fully eliminate.

And of course if illness is a war, then the battleground is the body and every patient a soldier. And this is the stuff of common cliché: memoirs, GoFund.me pages, and well-wishes often address major illnesses as “battles” or “fights.” Ritvo’s Four Reincarnations uses the trope, too, at least in its promotional copy. “When Max Ritvo was diagnosed with terminal cancer at age twenty-two, he became the chief war correspondent for his body,” his publisher’s website reads.

*     *     *

The connection runs in both directions. If illness is a war, then many people would also describe war as an illness. Here’s journalist Chris Hedges in his 2002 book War Is a Force That Gives Us Meaning: “I covered the war in El Salvador from 1983 to 1988. By the end I had a nervous twitch in my face” (and, he goes on to say, a propensity for aggression). “War’s sickness had become mine.”

That’s a metaphor, but only just. War is, after all, a massive proliferation of traumatic events, and these are what causes post-traumatic stress (a condition that might have afflicted Hedges). The chronic, disordered version of it (PTSD) involves witnessing or enduring a traumatic incident that causes such a huge neurochemical response that it damages parts of the brain. While it heals—if it heals—the sufferer endures emotional numbness and disconnection, the replaying of troubling memories in intrusive thoughts and nightmares, and fits of anger and fear, sometimes at little provocation. It’s not a problem specific to armed conflict—people with cancer can face it, too, and so can people who have been in intensive care—but war remains a potent way to describe the inner struggle of trauma.

Full-fledged illness isn’t necessary for any symptoms of trauma to occur. And rarely do descriptions of catastrophes address a pernicious change common to swift trauma and slow-moving tragedies alike: the inability to remember the time that came before. Lasting suffering with no guarantee of resolution has the strange ability to hijack human adaptability, to blot out the past—and, by extension, remove clear ideas of what should exist in the future in place of illness or disturbance.

The problem is so pervasive in post-traumatic stress disorder that “a sense of foreshortened future” (in other words, the loss of understanding that one could have a normal life) was long a diagnostic criterion for it. Indeed, the result of such changed perspective can be alarming. “I was evacuated three times by the U.S. embassy because of tips that the death squads planned to kill me,” Hedges wrote in 2002. “Yet each time I came back. I accepted with a grim fatalism that I would be killed in El Salvador. I could not articulate why I should accept my own destruction and cannot now.”

Circumstances aren’t always so shocking or so grim (as Max Ritvo’s poems will attest). The problem is common, and, in Hedges’ case and others, the reason rather obvious: he accepted it because he’d come to expect it, and lost the ability to imagine any other option.

*     *     *

Max Ritvo’s work was exceptional, but that was clearly only part of the poet himself. In his public appearances and own writings, he comes across as a youthful, exuberant, normal person. Some photos of him are a good reminder of how tender and baby-faced a young man can appear. In a Kickstarter video for the comedy troupe he’d joined, he was silly and sarcastic—an “inspiring cancer survivor” leaping around with his shirt off, offering “cardio kickboxing classes in Central Park.” His obituary says he’d fallen in love, too, and, despite wondering if it was wise, gotten married last year. Committed to the joy of ordinariness, he and his wife had banned the word “inspirational” from the speeches on their wedding day. He had no trouble seeing past his diagnosis and encouraging others to do the same.

But by the time of his death, that happy normalcy had receded into forthright expressions of misery.

From the first how-are-you of an interview this August 14, he called his condition “end-of-life stuff.” He reported suffering from fluid accumulating in his lungs, severe shortness of breath, and unremitting pain despite heavy doses of morphine. In previous years, he’d written, “We think bird, / and I feel gaseous wings ripen in my chest… and the watermelons of my lungs sob the sugar of flight.” Now he dispensed with frills and just said, “I kinda feel like I’m being water-boarded.”

It was a kind of slow torture, in other words. It was like war.

*     *     *

Cancer is not a Salvadoran death squad, obviously. It does offer its own equivalent of an embassy-orchestrated evacuation—in cancer, these are the interventions of medical doctors—but there’s not necessarily a way to escape death just by wising up enough to accept the help. Cancer, the uncontrolled proliferation of abnormal cells, resides in the unwilled body. Unlike trauma, it’s not beholden to the rigorous self-control that can (with luck) help a person outwit dark snares deep in the mind. Some cases are incurable from the start; some slip past the best interventions and make the lethal outcome clear long before death arrives.

In those cases, fatalism isn’t lethal blindness at all.

In May 2012, the writer David Rakoff, aged 48, made a final appearance on This American Life before dying of a cancer he’d originally beaten in college. “At dinner with friends recently, the conversation turned to what about yourself was still in need of change?” he said. “…Thanks to my rapidly dividing cells, I no longer have that feeling—although I remember it very well—that if I just buckled down to the great work at hand, lived more authentically, stopped procrastinating, cut out sugar, then my best self was just there right around the corner.”

And then, with indisputable dignity and wisdom: “Yeah, no. I’m done with all that. I’m done with so many things.”

Hard to argue with that.

*     *     *

Max Ritvo had the same dignified acceptance. A poem he published in The New Yorker ends with what could be read as a subtle gesture of equanimity towards death: “And if a whole lot / of nothing happens to you… that’s peace. / Which is what we want. Trust me.”

What is striking about Ritvo’s poetry, though, is that even in his musings about a world beyond this one, his imagination telescoped inward towards the end. “I’m not that sick in Heaven,” he wrote in a poem for a small literary magazine called The Grief Diaries, in a passage that compares the afterlife to a busy hospital with “clean syringes labeled Sleep.”

But: “I’m not that sick in Heaven”? There is something jarring in Ritvo not hoping for something better than a new shading of the illness he knew so well in life. One might’ve imagined he’d envision a vivid reset of imagery in the afterlife—not with some supernatural insight, but rather through his innate creativity. Put another way, one might have hope that Ritvo would accomplish in his dying what Hedges didn’t manage despite his living: to remember his way back to his healthy self, the war of illness or the illness of war. Not not that sick, in other words, but rather not sick at all. Stunningly healthy, even. Way beyond cardio kickboxing in Central Park. So damn vibrant he’s shooting off sparks.  It’s Heaven, after all.

But: nope. At the end, Ritvo was thoroughgoing in his literalism and presentism. In straightforward, clear-eyed words, he told an interviewer he’d had “the opposite of an insight” about the end of life: “I’m not going to figure it out, I’m not going to have an ‘a-ha moment’… I don’t know if people get the kind of existential resolutions that they think they do.”

The same sentiment appeared in his poems. In one particularly vivid poem, he wrote: “I thought my next thought would be a vision of my suffering; / I thought I would understand the yellow lightning in a painted storm— / …Instead I have this picture of dissatisfaction, / the thought not rising, but splitting in half….”

And, in another, a blank shrug in even more literal terms:

I used to want infinite time with my thoughts.
Now I’d prefer to give all my time
to a body that’s dying
from cancer.

The creative diminishment seems to have been cancer’s final blow. As reported in numerous media outlets, Ritvo told his family that when he couldn’t write, the end would be near. On Monday, August 22nd, he put down his work for the last time. The next day, he was gone.

*     *     *

It is hard to fault a dying 25-year-old for failing to accomplish a task that what most of us would also fail at. In a recent article, oncologist Siddhartha Mukherjee called the lived experience of cancer “a landscape more desolate and exhilarating than most of us can imagine.” It would make sense that, if it is hard to imagine such a stark, alien experience and harder still to path back from it, it is hardest of all to send poignant words across the void while also enduring enormous physical suffering.

But, in the end, by offering no insight, Max might have granted us one.

Maybe in the end the metaphors mislead, and it is not that war and illness are any more similar than any other comparison of calamitous circumstances that can afflict human lives. What is most similar between all the desolate, exhilarating landscapes is how taking up residence on any of them tends to obscure everything that lays beyond.

And maybe, rather than armed conflict and cancer existing side by side, it is the foreclosing of imagination and closeness to death that stand shoulder to shoulder in the human psyche.

*     *     *

“About that metaphor, the military one, I would say, if I may paraphrase Lucretius: Give it back to the war-makers,” Susan Sontag wrote in 1989. Sure thing; at the very least, the battle of Max Ritvo is over.

But if his Heaven should be better than another hospital ward, where should it be? A bank of clouds in the style of a New Yorker cartoon is a tempting cliché, if only because Ritvo was already in the magazine’s pages. But those cartoons are terrible—funny in a stupid way, like the spandexed yuppie fools who would actually kickbox in Central Park.

And there’s a better option besides. As of 2016, the US government has belatedly begun to heed Sontag’s advice. This spring, they announced a healthcare initiative called “Cancer Moonshot 2020.”

“Moonshot”: the term has replaced “war” (as in “War on Cancer”) as a way to suggest inspired, maximalist efforts at sweeping change. (Just like “war” wasn’t just for cancer—consider “the War on Drugs”—this term is in wider use. “Let’s have a medical moonshot,” global health expert Paul Farmer said at a press conference last year about rebuilding the healthcare system of post-Ebola Sierra Leone.)

Weirdly enough, the word predates Sontag’s disdain for “war.” In 1969, the philanthropists and advocates who pressed for a “War on Cancer” took their inspiration from that year’s most memorable event: the landing of the Apollo spacecraft on the moon. Recognizing that that stunning scientific achievements was technologically simple, they hoped the same would be true for cancer—and after realizing that that success would chiefly hinge on cancer research, they demanded Nixon launch a “war.” In large part, it meant committing public funds to scientific innovation.

It was an overambitious idea. Cancer is a vast category of diseases, some of which hadn’t even been discovered in 1969; curing it is not as simple as putting a man on the moon. (Even now, the Cancer Moonshot isn’t quite expected to cure cancer. Rather, its public website details a plan to perform experiments “in patients at all stages of disease in 20 tumor types in 20,000 patients within the next 36 months,” as part of a plan to “develop an effective vaccine-based immunotherapy to combat cancer by 2020.”)

Nonetheless, we’ve come to embrace the high hopes that brought that idea to the fore. And “Cancer Moonshot” is way more apt a concept than a “War on Cancer” ever was. The driving force behind such a large initiative wasn’t the constricted, joyless martyrdom of war. Grand, thrilling innovation is what ending cancer is actually about.

That’s also an apt description of Max Ritvo, too. His work was grand and thrilling, and it’s easy to imagine his Heaven as the moon—that strange, evocative, romantic destination, where improbably, impressively realized ambitions can reside.

That is no proper reprieve from “desolating and exhilarating landscapes,” of course. But perhaps, just as the Moonshot won’t quite cure cancer, there is something inexorable and irreducible about the singularity of human lives.

Then again, the opposite is true too. After all, in their bleak entrancements, all tragedies are somewhat alike. In the end, we’re all together on the moon.

*     *     *

For most of his adult years, Ritvo rejoiced in an ordinariness that other people took for granted. In the end, the Heaven he chose (“a hospital for souls”) was ordinary, too, although comfortable—separate from the rest of the world, but common, comprehensible, a place where eventually basically everyone goes. It was an idea that reflected the way suffering is universal and in the end no broad block to bliss.

Of course, if the moon and the hospital evoke the same basic ideas, then this all circles right back to what Ritvo said in the first place. Which is hilarious enough to seem pretty right-on.

Words Ritvo published last year say as much, in fact. They echo now with a faint, funny prescience:

You chase my face with your face
by making my faces:

Your lips form my stricken crescent
and mime the moving moon of my mouth.

You catch up and have my thoughts.

Good call, Max. Rest in peace, and we’ll see you on the moon.