What Cancer Taught Me

It was the quarantine Thanksgiving of 2020. Like so many other millennials that year, Vy, my future wife, and I were forced to be the adults in the kitchen for the first time. It was when I had my head bent to the candied yams and trussed turkey when Vy noticed I had a lump on the back of my neck. 

“It’s probably a bug bite.” I brushed her hand away.

Vy, who was a first-year resident in emergency medicine, simply replied, “That’s not a bug bite.”

The first thing that happens when your cancer relapses is phone calls. Phone calls, which lead to more phone calls. A horrid round of telephone calls delivering the news to every corner of my universe: The leukemia is back. It’s in my spinal fluid and brain. I need a bone marrow transplant.

I grew up attending Orange County Buddhist Church, a Jodo Shinshu Buddhist temple that was built after the mass incarceration of Japanese Americans during World War II. Our grandmothers and grandfathers made a home for generations, passing down the living tenets of Buddha, dharma, and sangha.

“Cancer has taught me about the ego and the self, about impermanence and mindfulness, suffering and compassion. It’s my dharma.”

The sangha is me, my family, my best friends, my community leaders—the same people who received the ripple of calls as I lay in a hospital bed, starting chemotherapy. As Buddhists, we’re taught to be egoless. As one link in the golden chain, one link in our sangha, I never felt like my identity was more than Kinuko’s grandson or maybe that tall boy who played basketball. In the hospital, day after day, bag after bag, I thought about my life—my ego rising, desperate to be heard. Did I have a meaningful life? Without a successful bone marrow transplant, one doctor said it may only be months. What have I done?

One treatment made the isolation both easier and far harder: a chemo injection into my spinal cord. The procedure was explained as an epidural, except instead of pain meds, it was a high-dose drip of methotrexate. I never looked at the needle, but it left a shadow on the OR floor. A bad sign. The headaches it caused blurred the days together, and I became delirious to the point of hallucinations. Although I spent most of my time sleeping, I tried to look at my phone a few times a day. Some days the hallucinations would be worse than others. Is that a mob of people breaking into the U.S. Capitol? Better take a nap. 

Every day I’d get a handful of new followers on Instagram. Most of them appeared to be Japanese American, and I didn’t think much of it. If I did, I might have realized that in the world beyond my negative pressure room and my own chemically addled brain, Buddhist temples from California to Washington were hosting bone marrow drives. My best friend sent me a message: “Had another good drive today!” Another? I looked back at unchecked messages. There were pictures of people I knew, barely knew, and had never seen before—all with Q-Tips in their mouths and a banner that said, “Save Paul.” 

Matches were more likely to be successful if we shared a common genetic ancestry. I called my mom and she said it was true—there were thousands of Japanese Americans trying to save my life. I even got a call from a blood bank in Israel. How they found out that my dad’s side of the family is Ashkenazi Jewish I will never know. I grew up thinking the sangha was all of us together. In the hospital, fighting for my life, I saw my sangha fight for me. 

It was my sibling, Laurie, who eventually became my donor. Even though the drives failed to find me a match, I’d later tell each person who swabbed that they may still change the life of someone in the future—likely someone in our community. 

As the drives ended, I entered into my next stage of treatment. The radiation and the bone marrow transplant were intense, almost medieval. I’d have to spend another month in the hospital as my body decided whether it would accept this new immune system. In this second round with cancer, the doctors prescribed the most treatment that could be tolerated by my body. Meanwhile, my mind needed a treatment of its own. 

So, I turned to writing. I wrote to escape but also to feel normal and useful—maybe even useful to my sangha—by putting down the stories from the community that raised me.

I wrote the feature script for No No Girl, a modern-day telling of the lasting effects of Japanese American incarceration and a family that must come together to heal from their past. I finished the script and shot the movie in the same year as my transplant. I was determined to change the narrative.

Eight months after being discharged from the hospital unable to walk, I was standing on set with an entirely Japanese American cast including an Academy Award-winning actor. I’d been through a chemical castration, the prescribed lethal dance between what my body could take and suppression of the cancer. I had survived it all. Aaaaaand ACTION! I was every character. I was every line. I was every precious moment, and after we wrapped, I was every cut, every footstep, every score. I proposed to Vy. I think it was ego that allowed me to feel like I had done something meaningful. That now, I was worth it. 

Being devoid of ego is hard when living feels like a defiance of death. My sensei at my temple talked about kalpas (eons) and the oceans of birth and death and how nothing is permanent and life is suffering, but there I was… 

We premiered No No Girl at the Japanese American National Museum in LA’s Little Tokyo. That was in August of 2022, and for the next eight months we’d travel the country screening the film, including at the temple that raised me.

For eight months I led a manic victory lap of a life that took me to Japanese American communities across the U.S. At every Q&A, people raised their hands and shared stories of their families and the intergenerational trauma that binds so many of us. In San Francisco I met a woman who told of being incarcerated at Tule Lake. We even became pen pals for a time. Wondering what it took to be in movies, she wrote, “I’m eighty-nine years old with grey hair, so if you need someone old, text me.”

Throughout this period of celebration, I was obsessed with my survival; self-preservation is ego-preservation. I clawed up a mountain from a valley of pain, and declared myself invincible. This is how cancer humbles you. It was two weeks after marrying my wife when I felt the lumps again.

During my third diagnosis, I would write again but slowly. There was no need to conquer my enemy anymore. Another year would go by and new technologies would lead to another remission. That’s where I am now, recovering again. It’s almost ten years since the first diagnosis, and even though I’ve “beat” cancer a few times, it’s never really been gone—just hiding somewhere in my body, very small. What’s different now is how I understand this part of me. I try to listen to its teachings.

Cancer has taught me about the ego and the self, about impermanence and mindfulness, suffering and compassion. It’s my dharma. My voiceless, killer sensei. To this day, I still probe my ego, asking myself if I’ve done enough. Have I led a meaningful life? But instead of chastising myself for an old thought I know I should outgrow, I think of the lines of people that tried to save me with their bodies, about playing basketball and making friends as a kid at my temple. I think about how I am a descendent of survivors, the founders of a beautiful and lasting community. 

I’ve always had a meaningful life, and I’m lucky to have a teacher that is so patient with me.