Cuddling the Skeleton

Even in the last months of his life, poet Max Ritvo craved intimacy—with close friends, and with fellow cancer patients, like me.

Playwright Sarah Ruhl and poet Max Ritvo
Playwright Sarah Ruhl and poet Max Ritvo.
Photo illustration by Slate. Photos by Zack DeZon and Ashley Woo.

Sarah Ruhl met Max Ritvo when he applied to her playwriting class at the start of his senior year at Yale. From the moment he entered her classroom, she writes in Letters From Max, the new book chronicling their correspondence, she was struck by his wisdom—“as though an ancient light bulb hovered over his head.” She remembers wondering, “Who is this boy?

Max was a poet—Ruhl had accepted him into the class in spite of this, intrigued by his application—and also a cancer survivor. In one of his first notes to her, he explains why he has to leave class early to grab a meal before a show: “I have to eat in a really regimented way to keep my weight up as a result of the cancer/chemotherapy I had in high school—more on that some other time.”

Sadly, due to a recurrence of his cancer the following month, “that” would become the primary theme of a remarkable exchange of letters that continued until Max’s death just shy of four years later, in August 2016. For a small part of those four years, I knew Max—we were treated in the same clinical trial at the National Institutes of Health in Maryland. Like him, I had battled Ewing’s sarcoma, a rare and aggressive cancer, and unlike him, I have had the good luck to survive it. In the years since my treatment, I have struggled to articulate my experience to people. Reading Max’s account of life with Ewing’s was a revelation, as honest and eloquent an expression of what it is like to be sick as I’ve come across. That his interlocutor was a playwright, as I am, made these letters even richer to me—as if I were viewing my own life from two separate but interconnected perspectives.

The frankness and warmth of the letters is in keeping with the Max I briefly got to know during our anxious monthly visits to Bethesda in the first half of 2015. But the power of Max’s insights doesn’t require having known him or even any familiarity with his wry, fervent, aching poetry—published in a chapbook, Aeons, his first book, Four Reincarnations, and a new volume edited by Louise Glück, The Final Voicemails. His prose, rich with the mischief, directness, and erotic buoyancy that made Max unforgettable to anyone who met him, effortlessly conveys complex ideas and captures his inimitable spirit.

That spirit, dazzling as it was, was also very human, and within these letters one can see Max’s occasional shame and reticence around his disease. In an early letter, Max frets that he behaved too “cancerily” (a brilliant Ritvo neologism) with an old friend, alienating her. Sometimes it’s Max who needs some distance from his cancer. In a bad-news update to his email list, he writes, “Bleak news, though no immediate death sentence impending.” This opening gives the recipients two options to focus on—and most people, in my experience, will choose the latter, which may have been Max’s wish.

But as Max’s disease progresses and death becomes more of a possibility, his letters open up. Ruhl’s attentive and loving communications are met by increasingly vivid and vulnerable reports from what Max termed “Cancerland.” Eventually, Ruhl suggests that they collect their letters in a book, and this is where Letters From Max blossoms, from something more modest—a tender exchange between a caring teacher and an eager student—into a resonant and profound contribution from two fully formed artists to the literature of illness. While the potential for publication may explain why Max’s letters suddenly became more literary, I think it’s more likely that he used the excuse of the book to try out new strategies and vocabularies to describe what he was enduring. Doctor’s visits and hospital stays, and their attendant emotions, only tell part of the cancer story. The deeper narrative is the psychic one, as real physical agony and the threat of death intensify cosmic questions, creating both clarity and new confusions about our existence.

This is the stuff most people don’t want to talk about. But Max wanted to, and Ruhl makes it clear that she is someone he can share anything with, without any worry about how it will make her feel. This gives Max the license to roam freely through his consciousness. Visiting the Mercer Museum in Doylestown, Pennsylvania, Max enters a seemingly bare room and soon discovers that he is positioned beneath a gallows. Meditating on this fearsome scaffold, he observes that “the heart and the throat both need so much protection, and depend so much on one another to be needed by the body.” Displaced in this way, anxieties about emotional dependence become especially poignant—dependency is literally a matter of life and death, but its emotional variant is almost impossible to discuss directly in our culture of individualism. In another letter, Max uses psychological metaphors to illustrate his inner state: “That night, in the shower, feeling alienated, I imagined how different my interior life is from the interior life people imagine me having. How my mind disrupts my ability to listen and be empathic by wondering what I look like at the moment… I thought about if there is another Max, a Good Max, coating me like a shell.”

But it is a philosophical exchange that perhaps most illuminates Max’s inner landscape. After a year of false starts, Max is finally able to write about what he thinks comes after death. Where Ruhl imagines some form of unitary consciousness surviving the body’s expiration, Max sees the brain as “full of first and second drafts of ways of thinking… Broken down, the storm of codes that happen to coexist in my brain seem to me perfectly willing to part from one another.” For Max, channeling Hume and Buddha, “the illusion of a unified consciousness” is directly tied to a unique life experience that “can never be recreated.” I found this a painfully intimate confession that Max believes he is going somewhere very different than where Ruhl imagines he might go.

The last time I saw Max, I was down at NIH to receive a vaccine and he was getting scan results. We sat in the waiting room and he excitedly asked me if I had seen the new CT machines yet, with their “cerulean light” enveloping you as they scan you. Max even spoke in poetry, though it always somehow sounded down-to-earth. Soon we were called into our separate treatment rooms. I’ll never forget the knock on my door, how when I said, “Come in,” thinking it was our doctor, instead Max’s thin frame appeared in the doorway. “It’s in my hips,” he said. The cancer had spread. We hugged wordlessly and then Max said, “We’ll have a bottle of red wine back in the city.” Not only was he promising us further time together, he remembered how, on a previous visit when he asked me if I liked weed, I had replied that I was “more of a red wine person.” Even at his darkest moments, Max reached for intimacy.

This is especially evident late in the book. A few months before he died, Max wrote the introduction for Letters From Max. Ruhl chooses to include it toward the end of the book, perhaps because of her “embarrassment about Max’s hyperbolic compliments,” which his early letters are also full of. But perhaps she also realizes what a perfect postscript the introduction turns out to be. After painting a lively and affectionate portrait of Ruhl, Max writes of their friendship, “We talked in person, on the phone, and through our letters, and became friends in the deep sense of You Are Not Alone.”

More than physical isolation, the sick fear spiritual and emotional aloneness—a lack of intimacy. As Max has a poem ask late in the book, “Who wants to cuddle a skeleton?” We approach death within our isolated, failing bodies, but to feel so cherished allows us to face our final agonizing tearing away from this life with a feeling that we are known and will be remembered. Intimacy can’t conquer death, but it can live on after it. Max ends his introduction by writing, “And now, if I ever hug you, it is Sarah hugging you.” She returns the favor through this miraculous book, allowing us to cuddle the skeleton—Max’s, as well as our own.

Letters From Max: A Book of Friendship

by Sarah Ruhl and Max Ritvo. Milkweed Editions.