Authors Amy Sedaris and David Rakoff do a cooking demonstration at the Texas Book Festival in Austin, Texas, United States.

Authors Amy Sedaris and David Rakoff do a cooking demonstration at the Texas Book Festival in Austin, Texas, United States. © 2006 Larry D. Moore. Licensed under CC BY 4.0.

David Rakoff came into my life on May 10th, 2012, via the big screen. “This American Life,” a popular radio program, was doing a live stream event into theaters. While I’d had a fleeting memory of hearing David’s sardonic, cat-like voice before, it wasn’t until his performance that night that I really took notice. He approached the podium on stage with his left hand tucked into his pocket. He looked slim, older, and possessed the sort of dignified, intelligent air of a person who could knock someone off their feet with a well-placed phrase. Rakoff began his piece joking about how he’d been “popping enough Oxycontin to satisfy every man, woman, and child in Wasilla” (Glass, 2010) due to pain in his arm. The surgery he’d undertaken to help alleviate the pain included the removal of a tumor in his left collar bone, and he’d already gone through over a year of chemotherapy. The audience laughed timidly at the matter-of-fact way he described his illness, treatment, and the loss of all feeling and control of his left arm after the surgery severed the nerves. The same audience cheered as he railed about being afraid to dance alone in his apartment only to begin dancing gracefully on the stage, utilizing his limp arm as a partner. He seemed to revel in how he could make terminal cancer and the loss of a limb into a poignant piece of entertainment. I left the theater a devoted fan. Rakoff was dead three months later, at the age of 47.

Rakoff was an essayist who loved describing himself as a pessimist, constantly looking for the worst-case scenario. Nonetheless, an absolute worst-case scenario- terminal cancer- never seemed to factor into his equation. Digging into his backlog of writing, I was struck by the balance of frankness and fortitude in his work. His illness both gave him the ability to define his life and dismiss it, even as it was happening right before his eyes.

Rakoff’s ability to communicate personal circumstances through a lens of wit and mockery is found in the prose discussing his illness’ inception. In his short story “I Used To Bank Here, But That Was Long Long Ago,” Rakoff tells of how, at the age of 22, he was diagnosed with Hodgkin’s lymphoma. He returned home to Canada to undergo chemotherapy and radiation. Rakoff notes his coping strategy at the time was detached at best. He describes his first cancer as “dilettante cancer” (Rakoff, 2002 p. 211). He goes on to say he felt like a “cancer tourist” (Rakoff, 2002 p. 211), despite losing his hair, having to quit his life living abroad, and suffering greatly over several months. He reflects on how he made everything into a joke, not in the name of keeping laughter in his life as part of his healing process, but rather as a shield to deflect emotions.

Rakoff’s steadfast approach to his health issues was akin to Cameron M. Hay’s “John Wayne Model” (Hay, 2010 p. 262), in which the patient uses “stoicism, independence, courage, and grit to continue to meet all normal societal demands” (Hay, 2010 p. 262). Indeed, Rakoff’s profession as a writer allowed him to communicate the realities of his illness while keeping himself working, thus keeping him in what Hay calls a “socially and personally beneficial” (Hay, 2010 p. 262) lifestyle. Yet, his stoicism was potentially served with an unhealthy dose of disregard. On paper, Rakoff could get away with sidestepping the negative and heavy parts of his life with a biting sentence and well-timed joke. While he might rail about the musical Rent for several pages, his reflections on his cancer came with an “I don’t know you well enough to hate you” helping of impartiality that seemed out of place coming from the person who experienced it. Hay describes the “John Wayne” approach as “allow[ing] patients […] to retain self-recognition as culturally viable and valuable persons” (Hay, 2010 p.263) but says “people who are seriously ill and follow a John Wayne approach to life often do so at considerable personal cost” (Hay, 2010 p.). Likewise, Rakoff admits that while he was “at my very funniest that year” (Rakoff, 2002 p. 225), his disassociation with cancer directly lead to his losing romantic relationships, and he was left with little but “curiously dispassionate memories” (Rakoff, 2002 p. 226).

It is also possible that Rakoff’s stoicism and way of approaching his illness directly impacted his lifespan. In When Breath Becomes Air, Paul Kalanithi wrote on becoming “inured” (Kalanithi, 2016 p. 81) to the suffering of his patients, and his trying to treat his patients without a personal connection was like “trying to learn astronomy by staring directly at the sun” (Kalanithi, 2016 p. 81). Rakoff’s writings on his illness could be similarly translated as facing them head-on while never connecting with the more significant questions of how his illness changed him or even killed him. He witnessed it happening but never allowed himself to process his illness fully. This disconnect may have led to his failure to seek treatment for over two years when, in his forties, his shoulder began hurting. His doctors discovered that the place on his shoulder, where he received the radiation in his 20’s, developed a sarcoma, or malignant tumor, brought on by those same radiation therapies. It’s conceivable that his prognosis might have been better had Rakoff not ignored the pain and sought treatment sooner. For better or worse, the diagnosis did little to change him. Once the cancer was discovered, he went back into treatment and attempted to continue with his life, even producing an Oscar-winning screenplay.

Rakoff’s arms-length approach to his illness was also spiritual. That Rakoff was raised as a Jew and attended a kibbutz in Israel might have influenced his theodicy, which Dein, S., Swinton, J., & Abbas, S. Q. described in their article, “Theodicy and End-of-Life Care” as “the intellectual defense of God in the face of evil and suffering” (Dein et al., 2013 p. 195). Rakoff did not blame a higher power for his cancer returning. He never asked, “why me?” In a 2010 NPR interview with Terry Gross, stating, “[y]ou know, the universe is anarchic and doesn’t care about us and unfortunately, it – there’s no greater rhyme or reason as to why it would be me” (Gross, 2010). This outlook coincides with one of Dein, S., Swinton, J., & Abbas, S. Q.’s tenants of Jewish theodicy, in particular, “anti-theodicy” (Dein et al., 2013 p. 198) where illness has “[n]othing to do with God: Evil simply happens” (Dein et al., 2013 p. 198). Without anything or anyone to blame, Rakoff made do with the tools he still had and kept writing.

Still, Rakoff was not without hope, even after discovering the sarcoma. He would balance his chances of living with could-be-worse-isms. In the same interview with Gross, he confessed, “it is a life-threatening diagnosis if it goes to my lungs in a sort of a more Jackson Pollocky kind of way, God forbid. I hope it doesn’t” (Gross, 2010). Even after it did pass to his lungs, he kept creating. While Paul Kalanithi avowed, “[t]he tricky part of illness is that, as you go through it, your values are constantly changing” (Kalanithi, 2016 p. 160), the public record of David Rakoff’s illness and death seemed to end where it began. His values, chiefly writing and being kind to his friends, never changed. His “John Wayne” (Hay, 2010 p. 262) approach allowed him to give interviews and readings between radiation, chemotherapy, and surgeries. He “prepared cookies” (Lovell, 2013) for guests despite only having the use of one arm and “getting weaker and weaker” (Lovell, 2013).

He also continued working and moving forward with his goals, specifically his ambitions to publish a book told completely in rhyme. Rakoff spent his remaining days finishing Love, Dishonor, Marry, Die, Cherish, Perish: A Novel, and then recorded the audio version. Ira Glass noted that Rakoff tucked a final word on his mortality into his fiction via a scene with a character dying of AIDS: “It was sadness that gripped him far more than the fear that if facing the truth he had maybe a year. When poetic phrases like “eyes look your last” become true, all you want is to stay, to hold fast” (Glass, 2017).

            “I need to finish [the novel], and then I’ll be ready,” (Lovell, 2013) Rakoff said to a friend. While his voice on the recording is often breathless and weak, he did not allow his cancer to steal his opportunity to complete his work. He taped in sessions, sometimes resting for hours between paragraphs, and finished less than two weeks before he died on August 9th, 2012.

While the way Rakoff handled his illness may initially appear inaccessible, his legacy is realized and communicated through his writing and his actions. He used his last breath giving anyone who wanted to know him a look into his life, and he did it on his terms. He might not have recalled his first cancer treatments with emotional clarity, but he left his books and essays behind to provide evidence of a life lived despite cancer and not because of it. David Rakoff died in the same spirit as he presented at the live broadcast; witty, creative, a little gloomy, yet persisting onward. My first and last memory of him remains the same: his slender form, dancing elegantly on the stage, to the music of Nat King Coles’ “What’ll I Do?”


Essay written by Natalie Wood for Dying Well, Harvard Extension School
October 5, 2021




Dein, S., Swinton, J., & Abbas, S. Q. (2013). Theodicy and End-of-Life Care. Journal of Social Work in End-of-Life & Palliative Care, 9(2-3), 191–208.


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