The title of Everyman, the mordant yet immensely moving 2006 novel by Philip Roth, comes from a medieval play of the same name, and is intended to remind us that aging and death await us all, every man and every woman. In 2009, Roth became the third living American writer to have his work published by the Library of Congress. As I have said before in these pages, Philip Roth is the greatest living writer never to have won the Nobel Prize in Literature.

Roth sets the tone for this 192-page novella with an epigraph quoting Keats.

Here where men sit and hear each other groan; / Where palsy shakes a few, sad, last gray hairs, / Where youth grows pale, and spectre-thin, and dies; / Where but to think is to be full of sorrow.

The novel begins with Everyman’s funeral, then skips backward in time to an unvarnished accounting of his life. The protagonist, who remains unnamed throughout, is a 71-year-old retired—and materially successful—advertising executive who has walked away from two marriages, three children, and his once-revered older brother, leaving him ill-equipped to cope later in life with his decaying body and a series of medical events—appendicitis, two heart surgeries, and various other procedures—that force him to confront his own mortality. His death-and-dying tocsin, though, rings well before his body fails him, at his father’s funeral.

All at once he saw his father’s mouth as if there were no coffin, as if the dirt they were throwing into the grave was being deposited straight down onto him, filling up his mouth, blinding his eyes, clogging his nostrils and closing off his ears. He could taste the dirt coating the inside of his mouth well after they had left the cemetery and returned to New York.

Everyman reaches old age and Starfish Beach, the retirement community his infirmities consign him to, cynical and resentful, unshriven (by two adult sons) for cheating on his first wife, unforgiving of the body that betrays him and robs him of his prodigious sexual vigor. Only his daughter from his second marriage remains loyal—as only daughters can. She sees to it that he is buried in a Jewish cemetery alongside his parents, even though he is an atheist, because she …didn’t want him to be somewhere alone.

The last to pay respects at his funeral is Maureen, a home health nurse who cared for him after his first heart surgery.

…a battler from the look of her and no stranger to either life or death. When, with a smile, she let the dirt slip slowly across her curled palm and out the side of her hand onto the coffin, the gesture looked like a prelude to a carnal act. Clearly this was a man to whom she’d once given much thought.

And that was that.

…In a matter of minutes, everybody had walked away—wearily and tearfully walked away from our species’ least favorite activity—and he was left behind. Of course, as when anyone dies, though many were grief-stricken, others remained unperturbed, or found themselves relieved, or, for reasons good or bad, were genuinely pleased.

I once recommended—prescribed—this book to a patient, now deceased, who in addition to being on dialysis with kidney failure, had heart disease so severe it was clear to all, my patient included, that he would not survive another year. A fiercely intelligent man, he understood his predicament intellectually, but refused emotionally to accept it. When he grew angry and then despondent, I suggested Everyman, which he agreed to read. He found the protagonist’s cynicism and bitterness and lack of grace so contemptible he vowed to die a better way. For the remainder of his life, a few months only, he was notably happier and at peace. Sometimes, only great fiction can tell the truth in a way that is transformative; we humble doctors lack the words.

Everyman is a profound adumbration that settles nothing, but fearlessly illuminates everything, leading the reader to a place where confronting death is at least possible.

Why do we fear death so? Do the atheists among us fear they are right? And the faithful that they are wrong? And this notion of bodily decay, how to deal with that, our unwanted senescence? Is there no limit to what we are willing to do to forestall it?

Perhaps it is the loss of those we love that we most fear. A different way of saying we fear losing our humanity. But what I have learned from my patients, I think, is that it is the sweetness of life, the intensity, the vividness we fear losing. And that the balm for this fear is to have savored fully all the heavenly ambrosia this mortal world holds.

Before youth grows pale.

In classic Aristotelian drama, there comes a moment when the main character is presented with an insurmountable obstacle, be it physical, psychological, spiritual, or otherwise. The nature of the obstacle forces the character to make a choice: a critical choice, an act of free will that determines the glide path of the rest of the story, irrevocably altering its arc.

So it is with the arc of illness, a medical drama wherein a patient is the protagonist, and his or her Aristotelian-type critical choice has consequences that determine not only that patient’s ultimate response to illness, but what that illness means.

Nemesis, a new novel by Philip Roth—passed over again for the Nobel Prize in literature; what are they waiting for?—involves precisely such a choice. It is a tender yet dispiriting story that illustrates how the meaning of human illness is not so much passively sought as it is actively wrought. Patients, Roth shows us, both discover and determine the meaning of the illnesses that afflict them.

For an excellent, in-depth book review of this novel, I refer you to the October 15 post by D.G. Myers on his fine literary commentary site, A Commonplace Blog.

The story’s protagonist is 23-year-old Bucky Cantor, a Newark (Roth’s favorite stomping ground) physical education teacher of superior physical strength and personal decency. Bucky, whose poor vision has kept him out of WWII, is engaged to a woman he loves and greatly fulfilled by his summer job of playground director at a school in the Jewish section of 1944 Newark, which is in the midst of a polio epidemic.

At first appearing immune while countless around him fall stricken and paralyzed, Bucky, too, eventually contracts polio, leaving him—a former college Javelin thrower—with a dangling, atrophied hand and a frail leg that causes him to hobble where he once strode with manly purpose.

It is at this point in the arc of his illness that Bucky confronts his Aristotelian moment, a critical choice that will determine his response to illness and bestow it with meaning. Unhappily, he blames God for infecting him, and himself for infecting others. He ends his engagement, quits teaching, and goes to work at the post office, choosing to live a joyless, solitary life out of anger, guilt, or both. Years later, when asked about his once-betrothed and whatever husband she might have chosen in place of him, Bucky has this to say: “Let’s hope their merciful God will have blessed them…before He sticks His shiv in their back.”

It needn’t be this way.

I have had the pleasure of meeting a young man who, when faced with a medical catastrophe of equally dire proportions—end stage kidney disease—bestowed a very different meaning on his illness than did the fictional Bucky. His name is Shad Ireland, and he is the first dialysis patient to have ever completed a true Ironman triathlon: a 2.4-mile swim, 112-mile bike race, and 26.2-mile marathon run.

Consecutively. As in, with no rest in between. Can you imagine? A dialysis patient doing an Ironman? Are you kidding me?

In Shad’s own words, from an article in the January 2008 issue of aakpRENALIFE, the journal of the American Association of Kidney Patients, “People should know that they are more than their diagnosis. A person’s attitude toward their illness has a huge impact, not just on what they can achieve, but on their total quality of life…My motto is ‘No limitations, only inspiration.”’

Aristotle could not have put it any better.