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Cancer & Creativity: One Chef’s True Story

While undergoing treatment for tongue cancer, Grant Achatz temporarily lost his ability to taste. Paradoxically, it taught him brilliant new ways to create flavor.

Grant Achatz preparing dessert at Alinea, 2011. Photo by star5112.

Grant Achatz preparing dessert at Alinea, 2011. Photo by star5112.

There is a motif in mythology of a person struck by an affliction of his most precious faculty: the blind painter, the deaf musician, the deformed beauty. The tongueless chef does not ordinarily figure into such catalogs, but Grant Achatz of Chicago’s Alinea, an F&W Best New Chef 2002, came close to being the first exemplar. He had noticed a painful spot on his tongue in 2003 and was told by a dentist that it was a symptom of stress. When it got bigger, he had it biopsied and was told it was nothing. In 2005, the pain escalated, but he remained stoic as he worked 18-hour days in the throes of opening Alinea. By 2006, Achatz’s tongue had become very uncomfortable, and he went to another dentist, who told him he was biting his tongue in his sleep and fitted him for mouth guards. In July 2007, an oral surgeon did another biopsy. The diagnosis was stage 4-B tongue cancer. The swollen lymph nodes he had thought might be mono were evidence that the cancer had spread to his neck. The risk factors for oral cancer are smoking and heavy drinking; at 34, Achatz had never had a cigarette and seldom drinks more than a glass or two of wine. “I was a cancer idiot,” he said. “I figured, They’re going to know how to knock this out, and it’s not going to be a problem.”

Achatz made an appointment with an oncologist. “So the guy goes, ‘It’s really bad. It’s very advanced. You’re going to have to have surgery,’?” Achatz recalled. “I’m like, ‘OK, what does that entail?’ He goes, ‘Basically, we’re going to have to take your tongue out.’ I said, ‘That’s not going to happen.’?”

Achatz went to see an expert in tongue cancer at Memorial Sloan-Kettering Cancer Center in New York City, and that oncologist agreed with the first. “I’m like, ‘What are the options?’?” Achatz said. “He told me, ‘None.’ So then I’m like, ‘Jesus! If you take out my tongue, what’s my quality of life? Am I going to be able to talk?’ He goes, ‘Not really.’ I said, ‘Swallow?’ ‘Severely compromised.’ I’m like, ‘What if I don’t do anything?’ He said, ‘You’ll be dead in about a month.’?”

Back in Chicago, Achatz decided to try one more oncologist, at Northwestern Memorial Hospital, who presented the same scenario, but then added that there was a group of researchers at the University of Chicago Medical Center working on organ preservation. So Achatz went straight to Dr. Everett Vokes, who said that he would try an experimental new protocol of intensive chemotherapy, followed by chemo combined with radiation, and then do surgery as necessary after that. “I’m like, ‘Yeah, where do I sign?’?” Achatz said.

He started the chemo almost immediately. Each of the 12 weekly sessions included a changing roster of medications—a sort of tasting menu of chemotherapeutic agents. After four weeks, the tumor was visibly shrinking. Achatz got his two sons, ages 4 and 6, to help shave his head into a Mohawk before all his hair fell out. And then the radiation began, targeting the area from his upper lip to his collarbone. “By the third week of radiation, my taste was going…gone,” he said. “Solid food wasn’t really an option. It was basically like getting the worst sunburn you could possibly imagine, all over the inside of your mouth and down your throat.” Unable to eat, Achatz plummeted from a healthy 160 pounds down to 129. The doctors wanted to insert a feeding tube, but Achatz refused. He was on IV hydration because he couldn’t even drink water. He had to wear a burn mask because the radiation had destroyed the skin on his chin and neck. On December 13, Achatz had surgery to remove the lymph nodes in his neck. The surgeons biopsied them, and they did a biopsy of his tongue as well. There was not a trace of cancer left.

Through the entire period of his treatment, Achatz missed only 14 days in the kitchen at Alinea. “How could you go through this without having something like Alinea to pull you through?” he said. “Everybody’s got to have that one thing, and this was it for me. The doctors told me that I was going to get to the point, from the chemo and the radiation, that I would not be able to physically get out of bed in the morning. So I set a goal for myself: No matter what, even if it’s just for an hour, I have to walk into the restaurant, just to show all 50 of these people who work with me that I’m alive, I’m here, I want to be here.” He shrugged apologetically. “I would come in and work 10 hours instead of 14 or 16. But I was involved. And though we lost 11 chefs, the ones who stayed knew that I didn’t need 50 shoulders to cry on, that what was really important was that this restaurant carry on at a very high level. And they did that. So it was like I didn’t want to let them down, they didn’t want to let me down, and we kind of met somewhere high up, and it was really cool.”

The execution of dishes can be done by Achatz’s carefully trained staff. “However, I think what I bring to the restaurant that is very difficult to replace is creative energy. Because even though it’s a collaborative effort, the dishes start with me.” As Achatz lost more and more of his taste buds to treatment, his mind was with his art. “I realized, as long as I can coherently form thoughts, I’m going to be thinking about food,” he said. “I would be sitting in the chemo chair and thinking about the fall menu. And I would go about the creative process the same way that I always did, which was writing ideas down first, based on ingredients that were coming into season. I would take a legal pad and write the dish title at the top, and I’d write all the ingredients that were in the dish. Next to that I would write how each ingredient was manipulated. Then I would maybe write a couple notes about a general flavor profile and how I thought it should taste. Then I would give it to Jeff Pikus, my chef de cuisine. He would start to work on it, and I would come in the next day, and we would talk about it. I couldn’t taste, but I knew how it was going to taste in my brain. There’s 90 percent that’s conception, and then there’s that 10 percent of validation where you actually put it in your mouth and do the fine-tuning. I can look at a recipe and go, ‘Five hundred grams of water, three grams of salt and six grams of sugar,’ and I know what that’s going to taste like, but there’s always some variation. You have to do that final taste. And Jeff could do that for me.”

Achatz had to adjust to the reversal. For years, he had tasted what Pikus had made and corrected it; now Pikus tasted what Achatz made and corrected it to the chef’s standards. “I’d honed his palate to the point where it was just like mine. I could give him something and go, ‘Does this need salt?’ He would taste it and go, ‘Yes, a pinch.’ I knew that it was basically me saying, ‘It needs a pinch of salt.’?”

When I talked to Achatz in March, he was beginning to get back his ability to taste, though he’d been told it would be a full year after treatment before he’d completely recover. “I would say probably 35 percent of my ability to taste has come back. Everybody knows that eating is pleasurable, but nobody really knows. I’ve got to tell you, it’s unbelievable not being able to taste. When I cooked for myself, I seasoned the food the way I thought it should be, even though I couldn’t taste it. I think I was afraid to lose my touch.”

And yet, Achatz has found inspiration in his temporary disability. “It’s going to make me a better chef,” he said. “They say that babies can taste only certain things when they’re first born. But as an adult, when you taste things, there’s always a blending of flavors on your palate. So imagine that you can taste salt, sweet, bitter and acid. Now strip all those away except sweet, because that’s the first thing that came back for me. So now all you can taste is sugar—a tablespoon of salt in my mouth didn’t taste like anything; it was really weird. You taste sweet, and so you crave sweet; all you’re eating is Häagen-Dazs ice cream. You’ve isolated sweet and understand it, because you’ve tasted it on its own. Then one day you have a swig of coffee. All of a sudden, you’re like, Wow, that coffee is bitter, I can taste bitter! A little light goes off, and now you are perceiving the pure relationship of bitter and sweet for the first time ever. You understand how they balance, when they are out of balance. It becomes a very intimate thing, very strange. Then when you start to taste salt again, you just put another piece in the puzzle. You understand how salt actually cancels out bitterness, and the relationship between salt and sweet.”

Achatz says the whole experience has transformed his cooking. “I’m a chef, and I understand that I’m cooking for these 80 people a night who come to Alinea—I’m not cooking for my palate, of course, because my palate is all messed up. I’m cooking what I feel is right for them. However, conceptually, there are components or ideas that I’ve added that are different now.”

Eating at Alinea is a wild ride. You are required to have a tasting menu, and the dishes arrive in procession, each vying to top the last one’s exoticism. They are presented on custom-made serving pieces, many of which resemble the implements you might find in the office of a Martian gynecologist. You have to play with your food; the night I ate there in March, I pulled a pin to make a potato drop into a bowl of soup. Wagyu beef was presented in a frozen sheet suspended from a kind of flagpole, and slowly thawed on the table before being draped over black truffle and potato. Things you didn’t know could be dried had been dried; nuts had been made into paper; a smoke gelée had been fashioned by smoking ice and then thickening the results. Only Achatz’s acute feeling for the exquisite interplay of flavors and textures saves the food from getting bogged down in gimmick. One cannot say that his dalliance with cancer has caused him to open up to culinary adventure, because he already had a sense of adventure worthy of Sir Edmund Hillary.

It has, however, allowed him some radical leaps. He cooked two dishes for me that he said had been occasioned by the loss of his taste buds. One was a dish of sweetbreads served with chestnut puree and a puree of burned bread. “Creatively, I’m understanding the way bitter and sweet work well together. So what can I put on the plate that’s going to be very, very bitter? Whenever you burn something it’s bitter, and I think of burned toast. So I crumble bread into crumbs and burn them in the oven. Then I puree them with water and salt and a bit of sugar. You taste a spoonful of that burned-bread puree alone and you just want to gag, because it’s so bitter. I would never have had the confidence to put a component like that on the plate, I don’t think, before this whole ordeal. But now I understand how the bitterness of that burned-bread puree works with the sweetness of the chestnut puree, and balances with the fattiness of the sweetbreads. You find complexities and balance and depth of flavor that you wouldn’t normally find, because you have these extremes. It comes together in the middle somewhere, and that’s very satisfying and unique. Before I went through treatment, I don’t think I would have had the confidence to intentionally burn food.”

Achatz then made me a dessert featuring chocolate and soy sauce. “This is a really special artisanal soy sauce from Japan. I smelled it out of the bottle and it just struck me—the earthy, caramelly, roasted nuances of it, this brininess like black olive and coffee bean. I thought, That smells like Occumare chocolate. I was looking at the soy sauce, and instead of thinking raw fish and wasabi, I’m thinking dark chocolate. I couldn’t taste it, so I melted some chocolate and put a little soy sauce on the spoon to have Jeff taste it. Before he tasted it, he looked at me like, ‘Are you frigging crazy?’ I’m like, ‘I think it’s going to work, I think it’s going to work.’ So we basically just made a ganache out of the chocolate and spiked it with a little bit of cayenne, not much. Then we put it on a plate with passion fruit, confit orange, soy-sauce marshmallows, soy pudding, freeze-dried soy sauce, lemon balm and lemongrass ice. And then a touch of rice pudding. So you come up with a basic play of salty-sweet. So now we have this balance, this canceling out, this complexity.”

“I wouldn’t want every dish on the menu to have these extreme yins and yangs,” Achatz said. “But I think over the course of a large meal, it makes things interesting to interject courses like that.” I had had the sweetbreads the night before we talked, but without understanding their etiology, I had not appreciated them at the same level. In the same way that a Jackson Pollock painting makes more sense if you understand the principles of abstractionism and expressionism, Achatz’s food makes more sense if you understand the process by which he arrived at it. If you see one Pollock, you might not get it; high-concept modernism requires repetitions to make any kind of logical sense. So it is with Achatz’s procession of dishes: They are not only individually delicious but also add up to something. They represent a certain intense relationship to flavors that is, for all the odd flourishes, purist; though the presentation may be baroque, the genius is in the simplicity of insight into food itself. The dishes taken together are the coherent narrative of a singular imagination. Illness has inflected that imagination, and so the story the food tells is not quite the same story as it was. The flavors have changed, and so has the logic.

I remember that when my father told me of Beethoven’s deafness, and of the fact that he never heard his own greatest music, I thought it was amazing that he could compose when he was deaf. And my father said that what was amazing was that he could compose such brilliant music at all. Talking to Achatz, I suddenly wondered if Beethoven had been able to write some of that music not in spite of, but because of his deafness. There is no more fundamental human power than the ability to find strength and meaning in adversity. In my last book, which was about depression, I wrote of the irony that people who suppress their history with the illness tend to be more disabled by the prospect of its recurrence than those who find emotional enrichment in their painful experience. It doesn’t really matter whether that enrichment is real; what matters is the subjective perception of it. So Grant Achatz’s engagement with the lessons inherent in his ironic loss of his sense of taste is a banner of resilience.

Could he have arrived at a chocolate-and-soy-sauce dessert or a burned-bread puree even without this trauma? Perhaps not—but it seems likely that he could have arrived at similarly imaginative and successful dishes. What his perceptions in this arena have to offer is a way to be grateful for his own trauma, and such gratitude is, for those who can muster it, the first great step toward healing and resolution. I asked Achatz about the possibility of a recurrence, about the fact that he could someday lose his tongue. “I feel like this has almost prepared me for that,” he said. “Now I know I could produce good work anyway, and enjoy doing it.”