Shattered and Adaptable: Two Books, One Truth About Being Human

A few weeks ago, I sat with an elderly man with locally advanced bladder cancer and his daughter. She was worried; he no longer seemed like himself. He slept most of the day. He had no appetite, not even for her cooking, which he had once loved. She described how he used to fill the kitchen with stories from his morning walk—the neighbor's new dog, the construction on Maple Street. Now he nodded when she asked about his day, his attention turned inward. She had tried everything: healthy meals, daily walks, and reading aloud the morning paper. Nothing seemed to help. His oncologist was pleased with the treatment. His primary care doctor found no alarming labs. Yet both sensed a fundamental reordering—invisible but unmistakable.

I thought of that encounter as I read "Shattered" by Hanif Kureishi and "Adaptable" by Herman Pontzer. These two very different books address the same mystery: when illness doesn't just affect the body, but changes the very way we live within it.

The Interior Landscape: Hanif Kureishi's Shattered

Kureishi's journal begins with a fall. His collapse in a Rome hotel room severed the connection between his mind and body. Suddenly paralyzed, he wrote not just to document, but to endure. "I am no longer a person—I am a body that requires management," he notes early on. What follows is a raw, unsparing account of dependency, frustration, and what remains when one's sense of agency evaporates.

Yet Shattered is not a lament. It is an act of defiance. Kureishi reclaims authorship not over his body, but over his voice. Through dictation, he reconstructs a self, one no longer grounded in movement or autonomy, but in imagination, memory, and fierce observation. As clinicians, we often meet patients at similar thresholds: when the old definitions of independence no longer apply, and a new identity must emerge—painfully, imperfectly, but honestly.

The Biological Blueprint: Herman Pontzer's Adaptable

If Shattered is an intimate portrait of what happens when the body betrays us, Adaptable pulls the lens back to reveal how survival has always depended on that very betrayal. Pontzer, an evolutionary anthropologist, argues that the human body is built not for performance or longevity, but for trade-offs. Every heartbeat, every immune response, every healing wound reflects a complex calculation: where to spend energy, and what to sacrifice in return.

In illness, these trade-offs become particularly apparent. The body makes calculated sacrifices in response to inflammation, tissue repair, or tumor defense—often at the expense of appetite, cognition, or mobility. Pontzer's thesis reframes these symptoms not as failures, but as evolutionary gambits. Fatigue, for instance, isn't weakness - it's strategy. Pain isn't punishment - it's a boundary, an alert system shaped by millennia of survival.

This biological view doesn't negate the suffering Kureishi describes. Instead, it contextualizes it. The very fragility he mourns is also the product of systems honed to help us adapt to scarcity, danger, or decline. And just as Kureishi rebuilds a narrative self from cognitive remnants, the body, too, improvises, cell by cell, system by system, to keep going.

This evolutionary lens suddenly made my patient’s experience less mysterious. The fatigue he describes, the cognitive fog, the complete reorganization of daily life—these aren't random cruelties. They're the body's ancient protocols activated, energy diverted from performance toward survival and repair.

Tension and Harmony: Two Ways of Seeing the Body

At first glance, Shattered and Adaptable appear to inhabit different worlds: one lyrical and visceral, the other empirical and analytical. Kureishi writes from inside the broken body; Pontzer writes about how bodies survive being broken. But both works circle the same truth: the human body is not a machine; it is a negotiation.

A profound insight emerges when we read these works together: what Kureishi experiences as a personal catastrophe, Pontzer reveals as a universal design. We are built to break down and rebuild, over and over. The question isn't whether we'll adapt, it's how consciously we'll participate in that adaptation.

Kureishi exposes the emotional terrain of adaptation, encompassing grief, rage, and quiet recalibrations of self. Pontzer shows us the mechanisms, the shifting gears of metabolism, the limits of repair, and the ingenious but imperfect design of life itself. One describes how it feels; the other explains how it works.

As someone who sits at the intersection of oncology and palliative care, I'm constantly struck by how adaptation happens on multiple levels simultaneously—cellular, psychological, relational. In clinical practice, we often toggle between these two modes. We interpret lab results and manage disease trajectories while sitting beside people whose worlds have been upended. When I explain to families why their loved one sleeps eighteen hours a day, I now draw on both perspectives. Yes, the cancer is consuming energy (Pontzer's trade-offs), but also—this is how humans have always conserved resources during threat (evolutionary context). It's not giving up; it's an ancient form of wisdom the body still remembers.

The tension between science and story, data and experience, is not a flaw—it's the terrain we walk. And perhaps the most human element of all is our ability to hold both: to explain the body even as we bear witness to its undoing.

What Remains

I often think about the moments when patients surprise me, not with their strength, but with their ability to keep remaking themselves. A woman who has lost her ability to speak finds new ways to express love. A man adjusting to life in a wheelchair who reclaims his role as a father. In these moments, I see echoes of both Kureishi and Pontzer: the vulnerability of collapse, and the quiet brilliance of adaptation.

I think of that elderly man and his daughter often. What they were witnessing wasn't just illness—it was adaptation in real time. His body was redirecting energy toward healing, even as his spirit sought new ways to connect with the world. Will he succeed?

We are not simply fragile or resilient—we are both. And in the space between what the body can no longer do and what the spirit still insists on, something irreducibly human emerges. That, too, is survival.