How Cancer Changed My Perspective On The Threat to Democracy

America has a lot to lose. As I’ve learned, you don’t always have as much time as you think.

('1st Amendment--Conservatives Being Censored' rally in Harrisburg, Pennsylvania on February 27, 2021. Photo by Paul Weaver / Sipa USA)

I didn’t need cancer to appreciate the grave threat to democracy America now faces. But the diagnosis did change my perspective.

The Republican Party’s slide into extremism — gradually and then suddenly, in the words of an Ernest Hemingway character — has been threaded throughout my four decades of political reporting for the Wall Street Journal, New York Times, CNBC, and CNN. The party’s increasing reliance on plutocrats for money and blue-collar whites for votes produced an incoherent coalition that, by the era of Donald Trump, left a single imperative: power at any cost.

That was a fact of life when Joe Biden’s administration began in the shadow of the Jan. 6 insurrection. But it largely remained in the background as the new president grappled with the COVID pandemic, economic recovery, and foreign policy challenges.

From the start, Biden declared that America was engaged in a global struggle pitting democratic systems against autocratic ones. In his second year, Biden delivered a major speech warning of the threat to democracy at home. In his third, I interviewed him on that subject. The political world mostly yawned.

A few weeks after the interview, however, something dramatic happened — to me.

After a busy fall of travel and public events, I returned home in early November for a routine annual physical. I felt great. I wasn’t surprised when my long-time internist pronounced me perfectly fit. She promised to call the next morning with the results of bloodwork.

When she did, I received an unforgettable shock.

“We have a problem,” she said. I had to head straight to the hospital.

The diagnosis at Johns Hopkins was as she’d expected: acute myeloid leukemia. After a lifetime blessed with good health, I had acquired a fearsome disease almost overnight.

Because of a random misfire in my body’s everyday cell division, doctors explained, leukemia spread like wildfire through my blood system. In the space of two to three weeks, they estimated, it had gone from zero to deadly.

An oncologist soon appeared at my bedside to obtain consent for starting chemotherapy — right away. “It’s urgent,” she said. 

Thus began my six-month treatment journey at Johns Hopkins Hospital in Baltimore. The speed of it all — even as I still felt fine — made the experience surreal. 

My treatment involved radiation and four separate rounds of chemotherapy. The first goal was to kill the leukemia cells in my body and put my disease into remission.

That, in turn, would clear the way for my path toward a cure: a bone marrow transplant in the fourth month. A successful transplant would give me a new, healthy immune system.

Through the ups and downs with fatigue, nausea, and loss of appetite, I monitored the progress of the most consequential presidential election of my lifetime. To keep my voice in the conversation, I recorded three new episodes of the Duke University podcast on democracy that I started in September 2023.

In early December, I prepared to record a podcast interview from the Hopkins leukemia unit. I had determined that draping blankets over my head and microphone would mostly muffle the beeps and whirrs of medical machinery. 

Alas, I never got to test it. My subject, former Trump White House aide Cassidy Hutchinson, had a change of schedule that moved our interview to a date after my discharge.

Transplant day arrived on Feb. 20. My brave 30-year-old daughter, who doctors found an ideal match, joined me at Hopkins that morning to donate some of her bone marrow. Within hours, nurses transfused it into my bloodstream through an IV drip in my arm. We both returned home that afternoon.

And five weeks later, we got the blood test result we wanted. My blood supply and immune system were now derived entirely from my daughter’s donated marrow.

The bone marrow transplant worked. Suddenly, I wasn’t out of time at all.

So, the miracle of modern medicine has allowed me to launch this newsletter at a critical moment. Nearly 250 years after it began, the American experiment in self-government may not have much time left. Voters face a presidential choice that could determine the durability of our democratic system.

Incumbent Joe Biden fits squarely within our familiar presidential paradigm. 

Ideologically center-left and temperamentally moderate, he governs in service of the entire country however anyone judges his policy choices. He works with political adversaries as well as allies to seek consensus on shared priorities.

His opponent promises the opposite. Donald Trump embraces the Jan. 6 insurrection and vows to pardon “hostages” now behind bars for crimes committed that day. He openly defies a judicial system that seeks to hold him accountable, including the New York state court where he’s now on trial. He holds our system of elections and the rule of law itself in contempt. 

Trump makes authoritarian leaders his role models. He aims to turn the federal government into his personal instrument for rewarding loyalists and punishing adversaries. He speaks the language of violence, stoking hate, fear, and prejudice among his supporters.

That formula could win at the ballot box. In fact, judging from public discussion of the race in recent months, Trump is on track to win.

In my view, the inordinate focus on early polling has been misplaced for two reasons. The race is almost certain to be close, but it’s too early to meaningfully assess the likely outcome. 

More than that, the difference between the candidates and the futures they promise are by far the most important topics for American voters to consider.

“Not the odds, but the stakes,” as NYU journalism professor Jay Rosen likes to admonish the media. I agree so much that I’ve made The Stakes the title of this newsletter.

America has a lot to lose. Voters head to the polls in just over six months — the same span of time that has passed since my diagnosis. As I’ve learned, you don’t always have as much time as you think.

Look out weekly for The Stakes, where I will write about Trump, Biden, and everything at stake for America’s democracy ahead of the 2024 elections. If you are not already signed up to receive The Stakes in your inbox, subscribe now.