A Thought Experiment, Made Real

I’m catching up on The Good Place, which, if you haven’t seen, is definitely worth watching. Last night, I was fascinated watching The Gang tackle the classic moral conundrum of “The Trolley Problem,” especially when Michael decides to stop making it a theoretical scenario and subjects the humans to a recreation of the scenario.

Patrick Koske-McBride
4 min readMar 9, 2021

But it got me thinking about one sentiment that every single cancer survivor faces sooner or later, “This is so horrible; I wish it wasn’t happening,” or, “How should I respond to [X scenario/issue]?” Well, much like Michael teleporting people to a runaway trolley, you don’t have to be theoretical about it.

One of the more interesting aspects of cancer survival with a master’s in biomedical science is that I’m very much aware that cancer is, on a cellular level, an unavoidable fate. It’s the slow accumulation of tiny little errors on a genetic level that occur on a regular, cellular basis. Think of it as the normal degradation you see in a car engine. I mean, yes, you can park your new Ferrari in the garage and never, ever drive it, but that will lead to other mechanical issues that can’t be avoided. When we buy a car, we’re aware that, sooner or later, something catastrophic will happen, which is why we have warranties and mechanics. There isn’t any of this stupid, “If you get your car regularly maintenanced and screened, nothing bad will ever happen” rhetoric surrounding vehicle ownership in the same way that chronic diseases are; we know that if you need to get from Point A to Point B frequently, you can expect some sort of disaster sooner or later.

Cancer survivors face a unique conundrum in this way; I don’t imagine black or LGBT+ folks can look at the sea of (majority) faces and think, “You’ll get yours one day, buddy” in the same way that cancer survivors can. Which brings up a fascinating counterpoint to everyone offering up weird empathizing strategies: unlike other scenarios that are largely-hypothetical in life; cancer survival absolutely doesn’t need to be that way.

You, dear reader, could participate in this with just some minor changes in your every day living. You could go snorkeling at Fukushima or tour the Chernobyl Exclusion Zone, get hundreds of CT scans or X-rays, ingest carcinogenic substances (that’s a long list; I guarantee you, you’re getting exposed to all sorts of carcinogens and radiation in your daily life), etc. if you want to get a jump on it. If getting cancer right now is unappealing (and I understand it’s not for everyone), you can just take up some minor unhealthy habits, and develop the disease in your 50’s or 60’s, when most people get it (and, trust me, AYA survivors die all the time from this ingrained “young people can’t get cancer” belief all the time)(certainly, it’s a stumbling block in every single social situation to start a discussion about how I spent the last decade in a revolving door of ORs and infusion centers in a way that wouldn’t bother a dinner party for upper-middle-aged women). Again, all it would take is a few slight tweaks in your every day habits to make you slightly more-susceptible to cancer (again, even if you lead a healthy, virtuous life, you will eventually get cancer).

You could do that; get a full course of treatment and scans, survive (or not), and you, too, would have a total understanding and empathy for what we go through. Chronic diseases are discussed in the dry abstract in society, but they need not be. You can go out and develop one. Or you can play it safe, lead a virtuous life, and you’ll develop one.

Here’s my nagging, unfortunate suspicion, though; no one will take me up on that offer. It’s a reworking of Jane Elliott’s question to white audiences if they’d be okay being treated the same way black citizens in America are, and, here’s the kicker; it really doesn’t matter what you do right now, you’ll end up with some horrible, catastrophic medical condition eventually. My raison d’être is to warn everyone about this inevitability in time for us all to make it easier when a medical technician frantically ducks into the examination room and tells us not to go anywhere until the physician talks to us.

And here’s my thought to everyone who won’t take up smoking or eating more red meat at my behest — you must be, on some level, aware of the horrible, terrifying nightmares that we face, from crushing medical debt, social stigma, and death, and, if you aren’t out developing a solid smoking habit or touring Fukushima; you’re more or less fine with other people being consigned to that fate. My question is; why are you okay with that for other people, and, inevitably, yourself?



Patrick Koske-McBride

Science journalist, cancer survivor, biomedical consultant, the “Wednesday Addams of travel writers.”