We lived in a place between mountains in the trout lands. The fish dwelt in the chill of eternal movement, slick and lithe and beautiful, in the curve of sapphire rivers twinkling with western sun. This was why we’d moved to Montana when I was a boy — to chase fish, in the church of my father’s religion.

There are many ways of not knowing, not seeing, and there are equally many ways of knowing, of coming to know deep in your body, embodying knowledge the way my ancestors embodied culture, the way the earth embodies language and spiritual belief and insult. Or maybe what I want to say is that it takes many ways of knowing to overcome your brain’s many refusals. To admit you know a thing like cancer resides — is seizing control — inside your body.

I have to say, what kept me there was not the science but the place. I wanted to be there in a way that had purpose. I didn’t want to visit or go on long kayak trips. I wanted to spend my life in Prince William Sound. For five years I lived at a field camp for three or four months at a time. The work gave me a purpose for being there: a part to play in protecting the ecosystem.

I’m convinced the most accurate way to gauge your survival odds when you have cancer is not by the size, type, or grade of the tumor but by the size and splendor of the tropical-fish tank in your doctor’s waiting room. If it’s over thirty gallons and stocked with anything neon, you’d better start wondering why they want you so calm.

I don’t remember feeling fear, only exhilaration and gratitude, like in my dreams. A feeling of ah. The sky was brilliant blue, cloudless. The balloon was yellow. We rose and rose until the pilot turned off the burner, and then it was quiet except for our voices, the creaking basket, and an occasional whoosh of air against nylon. From five thousand feet, everything on the ground seemed small, forgivable.

It is time for him to mark the spot that he will cut out. I turn around in the chair, and the starched edge of his white coat brushes my naked shoulder as he moves behind me. I can smell the magic marker and feel the cold circle he draws on my back. He asks if anybody is here with me, and I say no. I know what he’s thinking: that he won’t have to come out and talk to the relatives in the waiting room after the surgery is over.

You have to notice beauty when it appears. That means you have to show up and shut up. If I could give just one piece of advice to all medical students, I would say, “Show up completely, and then shut up for at least two minutes while the miracle in front of you tells you who they are and how you can help them.” If every doctor did just that one thing, it would change medicine.