A patient recently diagnosed with cancer writes how with the help of the people she loves, as well as the wisdom, humor and empathy of books, she has continued to navigate her new country: “Cancerland”.
Last October, I walked into a nondescript medical building in Richmond, Virginia, and left hours later a new subject of what I call “Cancerland”, my identifying papers the photo of a 5-centimeter tumor in my upper rectum.
I had been proud of myself for bucking the trend — look at me, getting a routine colonoscopy during the pandemic! When I awoke from the procedure, the technician who had joked about my New Orleans Saints face mask (he’s a Cowboys fan), seemed much less jocular. He wheeled me into a small room where the gastrointestinal physician said to me and my significant other, “we found something,” and handed me the tumor’s image on a printout. I stared at it for a few moments, groggy and confused. I asked, “how often do you see this?” His response: “One in a thousand.” Dread filled my body.
Journalists and novelists describe cancer citizenship in various ways. British writer Christopher Hitchens’s severe pain one morning effected “a very gentle and firm deportation … from the country of the well across the stark frontier that marks off the land of malady.”
Susan Sontag begins her essay “Illness as Metaphor”, “Illness is the night-side of life, a more onerous citizenship. Everyone who is born holds dual citizenship, in the kingdom of the well and in the kingdom of the sick.” In Emily St. John Mandel’s recent novel, “The Glass Hotel”, one of the characters ruminates, “a medical misfortune sends you into the country of the sick — which has its own rituals, customs, traditions, and rules.”
Like any nation, cancer has its political factions. The cheerleaders incessantly seek to uplift our chances at cancer survival: “We will beat this!” “You got this!” “You’re a warrior!” This rhetoric brings to mind Jimmy Valvano — “Jimmy V” — the effervescent North Carolina State men’s basketball coach who, when diagnosed with adenocarcinoma in June 1992, vowed to fight it. Two months before he died in April 1993, he brought watchers of an awards show to tears by insisting, “Cancer can take away all of my physical abilities. It cannot touch my mind, it cannot touch my heart, and it cannot touch my soul.” On the other side are the defeatists: Even as we may choose quantity over quality in longevity with body-shattering chemicals, they insist, cancer dominates us physically and psychologically. However unwelcome and deleterious, cancer is an omnipresent companion.
Most “Cancerland” citizens are moderates. They align with principles of both parties, often going back and forth. For me, exhaustion and nausea from chemotherapy are pebbles in my psyche: you are sick, you have cancer. On better days, I forget about it, and when a friend’s “checking in” text reminds me, I respond, “feeling good,” which is genuinely how I feel physically and about my prognosis. Regardless of worldview, most cancer sufferers appear to respect one another for whatever decisions are made or whatever view is espoused. I deeply appreciate this empathy.
Now that I have the disease, I grimace at memories of my sister’s breast cancer experience six years ago. She is more spiritual than I, so when she described a dark presence existing alongside her during diagnosis and treatment, I paid it little mind. Instead, I focused on researching the history and science of cancer because, well, that is what academics do. The magnificent book “Emperor of all Maladies: A Biography of Cancer” by physician and researcher Siddhartha Mukherjee provided the context for my primary question about my sister’s suffering: Is breaking down an entire body with chemotherapy really the best we can do to get at malignancies?As much as I learned from Mukherjee’s book, my “research” now feels smug and self-satisfying. My sister understood what I now know — with cancer, we exist is a fugue state. So in my new cancer venture, I am back to reading novels, always my go-to, and have noticed that rarely one goes by without cancer or other disease as part of the story.
As word of my cancer passes around to friends and acquaintances that I have met over five decades of life, they send me letters, cards, and gifts. I began requesting books, and my lovely friends responded so quickly that book piles on my windowsill provide me comfort (“we got you!” the books seem to express as I rest in bed). People want to show their love, express their shock. And cancer is dreadful. In “Illness as Metaphor”, Sontag, herself grappling with cancer, writes that “conventions of treating cancer as no mere disease but a demonic enemy make cancer not just a lethal disease but a shameful one.” Cancer presents as sinister, Sontag asserts, because it is not understood “in an era in which medicine’s central premise is that all diseases can be cured.”
Despite dissecting and critiquing the personal shame that accompanies a diagnosis, Sontag never mentions her own cancer in “Illness as Metaphor”. I understand. When my cancer was confirmed, for weeks I would not speak about it to anyone other than my family, close colleagues, and a few other “Cancerland” natives, mainly my sister. It is actually easier for me to write this than to talk with my friends, who persist in contacting me despite my silences. Sontag suggests that ominous associations with cancer will fade with a cure, which, her essay implies, will happen soon enough.
Decades after Sontag’s book was published, the dark metaphors (and lack of cure) continue. Consider this observation from the main character in Gail Honeyman’s “Eleanor Oliphant is Completely Fine” (a book given to me recently by a wonderful friend who knew I would love the irritable Eleanor): “These days, loneliness is the new cancer — a shameful, embarrassing thing, brought upon yourself in some obscure way. A fearful, incurable thing, so horrifying that you dare not mention it; other people do not want to hear the word spoken aloud for fear that they might too be afflicted, or that it might tempt fate into visiting a similar horror upon them.”
Of course, I wish I had evaded “deportation” to this new land. But here I am. My oncologist informed me that 70% of patients who undergo my treatment plan will survive. “90% who refuse the treatment … will not,” he followed. After these next few weeks, during which I will complete the last of three treatment phases (surgery; radiation/pill chemo; and intravenous chemo), I wait. Specifically speaking, four years and four months during which I will be scanned and examined before being definitively declared no evidence of disease (NED) … or not.
Meanwhile, with the help of the people I love and, as always, the wisdom, humor, and empathy of books, I continue to navigate my new country.
Juliette Landphair works in Student Affairs at the University of Mary Washington and is the mother of 19-year-old Samuel and 23-year-old Katharine.
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