Cancer Talk, #1: Framing and Perspective – 7/23/19

Cover art from The Emperor of All Maladies: A Biography of Cancer, by Siddhartha Mukherjee

I dislike some of the ways we talk about cancer. I reserve the right to change my mind about everything that follows, but for the moment this is how I feel.

The word “cancer” is too broad. There are so many types of the disease, and so many variations within each type, that the word loses meaning. Some types, if caught early enough, are curable. Others progress so slowly that we’re more likely to die with them than from them.  And of course, some are nearly certainly death sentences, and quickly. Lumping all of them into one big category seems unfair to the people in each sub-category.

Merriam-Webster lists ten different words for snow, from grue (thin floating ice: snow), to graupel (granular snow pellets), to corn (granular, formed by alternate thawing and freezing), and more. Some kinds, like a blizzard, are catastrophic. Others, like skift (a light fall of snow or rain), not so much.

Cancer is like snow. It needs more words.

We too often talk in hushed tones about people who have cancer, as if we’re already at the funeral. This feels insensitive, degrading.

We treat people who have cancer as if they’re heroes. This seems insulting to actual heroes. Bad things happen to good people through no fault of their own. Making them into heroes diminishes actual heroes who choose to run toward bad things; people like combat veterans, firefighters, police, and people who speak truth to power and stand up to abuses.

But, you may say, heroism is not about what happens to a person, it’s about how they respond to it. Fair enough, let’s talk about that. If a person has cancer what do they do? They get it treated. Same as if they have diabetes, high blood pressure, heart disease, the flu, an injury. Are all of those people heroes too? If so then the word “hero” loses meaning.

“Point taken,” you may say, but cancer treatments can be worse than treatments for those other things. People who persevere through bad things really are a kind of hero. Ok, well consider this: Depending on the type of cancer, there are people walking around with conditions that are potentially far more life-threatening or far more harrowing to live with on a day-to-day basis; multiple sclerosis, Alzheimer’s, a spinal injury (e.g., Christopher Reeves or Charles Krauthammer). What about all those people? Aren’t they heroes too? Why elevate cancer patients above any of the others? It seems unfair, disrespectful.

We too often act as if people who have cancer are snowflakes, as if to say “You poor dear.” Ick. Stop it.  There are tons of things endured by regular people every day that are inconvenient, difficult, painful, annoying, inconvenient. Examples include living with a chronic condition like diabetes or arthritis, persevering through an injury and the physical therapy afterward, going to the dentist, cleaning dog poop from the carpet, dealing with insurance companies, finding a place to park. What of it? Do they melt? Give up? No. They deal with it. As the Brits say, “Keep calm and carry on.”

The question “why me?” is selfish. We act as if getting sick is rare. It’s not. I mean, think about it. The number of ways we can get sick or injured is astronomical. Statistically speaking, having a significant health problem seems more likely than not; more the norm than the exception. It’s a rare person indeed who makes it through life without having to deal with some sort of major health issue. A more pertinent question is “Why not me?”

Same for “It’s not FAIR!” Don’t get me started.

The lapel ribbons we wear to show awareness or support are mostly self-aggrandizing virtue signaling. “Look at me, I care. I’m a good person.”  I’m happy for you.  And what about the diseases and conditions that don’t get ribbons? We’d run out of colors.

We too often talk as if people who’ve completed treatment have “beaten” cancer, as if it is Goliath, they are David, and Goliath is dead. Are you sure about that? I’m not. Keep your eye on Goliath. He has a way of coming back from the dead, and oh by the way stronger than before, and tougher to defeat. Goliath is relentless, and he adapts. The reality of cancer is more like that of a recovering alcoholic; one is never truly free of the disease and one must be ever vigilant for, and guarding against, possible recurrence. To allow a person to think they’re cured seems almost cruel.

In the movie Bridge of Spies Tom Hanks plays a lawyer defending a Russian spy who’s been caught red-handed.

Hanks: You could get the death penalty. Aren’t you worried?

Spy: Would it help?

That’s how I see cancer. It’s just a thing, among millions, that can happen to us. We deal with them as they come. Catastrophizing it, speaking about it in hushed tones, hero worshiping, moaning about fairness, virtue-signaling that we “care,” all seem wrongheaded to me. The sentiments seem backward. It seems they hinder more than they help.

I’m no hero, nor am I a snowflake. We all die. Some of us just happen to know ahead of time, based on statistical averages, approximately when and how it will happen.

My cancer is one of the types that people tend to die with rather than from. According to the averages, if it does get me, I have years left, not months. And in the interim, new treatments may become available. But then again, not all cases play out in accordance with the averages. From the very beginning, my case has not been average. My age when I was diagnosed was about twenty years younger than that of most people who get this type of cancer, so who knows?

It’s fascinating, really, how this experience affects one’s thinking. In a weird way, it’s a privilege, a blessing, in that it confers a perspective, an appreciation, and an urgency, to every-day life that I didn’t have without it. In some very important ways, my life is better now than it was before my diagnosis.

I have more thoughts about all of this, which I anticipate blogging about in the future, not for sympathy of course (see above), but because it’s intellectually interesting.