The slide on the screen illustrated a lecture about cancer research. It showed a magnified image of metastatic breast cancer cells that had invaded someone's lung tissue. Nothing to smile about. But I had spent so much time being afraid of cells like these that it was a relief to actually see them, to meet up with them in the anonymous dark of a university lecture hall, and to know them for what they were.
I felt a kind of calmness that day, the way I'd felt on a night long ago in 1991, during a battle in the Iraqi city of Kirkuk, when the sky suddenly lit up with a streaking peacock's tail of green and blue tracer fire. The explosions were beautiful and deadly, like the multifoliate metastasis on the medical lecturer's slide. A newspaper reporter at the time, I had been afraid of finding myself in the midst of a firefight. But when it actually happened, the fear dissolved. "So it's this," I remember thinking. "But it's only this. I will survive it, or not. And if I do, there will be one less thing in life to be afraid of."
The day in 2004 when the radiologist told me I had invasive cancer, I walked down the hospital corridor looking for a phone to call my husband, and I could almost see the fear coming toward me like a big, black shadow. I had been so sure the call for more tests following a routine mammogram would turn up nothing that I had gone to the appointment alone. Now I knew if that approaching shadow caught up with me, there was a good chance it would crush me. I would crumple into a sobbing heap.
The fear coming for me was an old adversary. I had been afraid of breast cancer, as I suspect most women are, from the time I hit adolescence. At that age, when our emerging sexuality is our central preoccupation, the idea of disfigurement of a breast is particularly horrifying. There were plenty of things I had more business being afraid of: actual, statistically significant risks such as boyfriends who drove too fast or drank too much, party drugs from sketchy sources, adolescent recklessness in treacherous surf or on too-difficult ski slopes. But somehow my imagination could not compass the very real, proven danger of these behaviors; cancer was the killer that stalked my teenage nightmares.
It is a most commonplace fear. Although a cursory exploration of health statistics reveals that heart disease kills many more of us, cancer remains our most potent metaphor for that which is deadly and dreaded and out of our control. In the last century, wrote Susan Sontag in her memorable 1978 essay “Illness as Metaphor,” it was tuberculosis that provoked fearful fantasy. “Now it is cancer's turn to be the disease that doesn't knock before it enters...treated as an evil, invincible predator.”
Why is this? Blame the movies, in part. If screenwriters have to kill off a female character, they love to give her cancer. We've seen so many great actresses go down to the Big C: Ali MacGraw, Meryl Streep, Emma Thompson, Debra Winger, Susan Sarandon.
Hollywood cancer distorts the truth of the disease in two highly significant ways. In a study of American movies from the 1930s to the 1990s, more than half of all cancer patients depicted are under 30, and three-quarters under 40. In the real world, cancer is overwhelmingly a disease of older age.
So if cancer in general and breast cancer in particular are mostly survivable, why are we still so afraid? Perhaps it is because we are just not that up-to-date; our perception of cancer's lethality is lagging the statistical reality by a decade or more.
Perhaps the fear is also a product of our fortunate First World lives. In countries with good maternity care and without childhood epidemics, most of us are likely to reach adulthood before anyone we personally know dies of anything at all. Unless we live in the inner city, or came of age in the 1980s AIDS explosion, fewer still among us will know someone who dies young. But some of these few will be cancer deaths. And if the young person is a celebrity, we will read all about it over and over again. So that when we come upon a statistic that is truly alarming—say, that one in eight American women will get breast cancer—we subject it to imagination rather than information, failing to note that the incidence increases dramatically as we age (in our 30s, for example, the odds are only about one in 233) and that for many women, breast cancer will be a disease that one dies with, rather than dies of.
Like me, my half sister was among the one in eight. Almost two decades older than I, she received the diagnosis in her 60s, when the incidence of breast cancer begins its marked increase. A feminist, environmental activist, and believer in alternative therapies, she was deeply suspicious of high-tech medicine. She had her lump removed but refused to undergo radiation or chemotherapy. Given the type and early stage of the cancer she had, her decision, at the time, seemed a logically supportable one. She felt that not enough people consider whether it is morally justified to chase after uncertain cures even though the radioactive material used to do so would linger dangerously, polluting the planet, for centuries. She felt, also, that chemotherapy prolonged life at too high a price. Instead, after her surgery, she went traveling to places she had always wanted to see. By the time it became clear, just two years later, that her cancer had metastasized and soon would kill her, she had visited Europe, Hawaii, and Crete. She died, eight years ago, seemingly at peace with the choices she had made.
Because of those steroids and white cell boosters, I never took to my bed. I never threw up. I covered my bald head with beautiful scarves and went on as usual, taking my son to school, walking the dog, going to the theater, seeing friends. Life developed its own odd rhythm: I learned to allow for one lousy week immediately following treatment, and then to expect two pretty ordinary ones, when I felt almost normal and forgot about cancer for hours at a time.
There were gifts I would never have received were it not for cancer. Friends and family showed their love in every conceivable way, from casseroles and flowers to handmade necklaces and copies of diverting trash such as the National Enquirer. From Denver my atheist friend sent a note saying that as he could not include me in his daily prayers, he was including me in his daily anxieties. I felt buoyed by believing friends who sent Lourdes water or pictures of the Medicine Buddha, stood up to pray for me in synagogues or arranged for a monastery of Tibetan monks to chant on my behalf. One friend trudged into Kurdistan to tie a scarf to a holy rock, another solicited the prayers of a Shiite ayatollah. The very ecumenism of all this reminded me of the many odd corners my life had led me into, and made me more appreciative of the time I'd already had to live so fully, to travel and explore.
Like my Denver friend, I am not a believer, and cancer didn't convert me into one. But although I didn't consciously turn to any higher power, I did experience something for which the only useful term I can find is “grace.” It is hard to explain the feeling, but it was a sense of being given just as much strength as the time demanded. I thought of the physicist Niels Bohr, who reportedly kept a horseshoe over his door. Friends would say to him, disparagingly, “You can't possibly believe in that,” and Bohr would answer, “Of course not.” And then he'd add: “But I hear it brings good luck whether you believe in it or not.”
I saw another side of my husband, whom I had always loved for his abundant, productive energy, not knowing that a gentler, patient man lurked within. Setting aside my book deadlines, I had more time to enjoy being with my son, then just 8 years old. The steroids I took gave me an unnatural, jagged energy and kept me up at night. It wasn't fun, being unpleasantly wired. Sometimes I felt as if I'd been taken over by an incubus on those steroid-addled days and nights. But even this had an upside. When my son would wake from a bad dream, instead of grunting sleepy words of consolation and ordering him back to bed, I'd invite him to join me for hot cocoa and a midnight chat.
Lest this sound like Pollyanna, I want to acknowledge that my experience was shaped by my good fortune. I had the support of a loving partner and fabulous friends and family. As a writer, I controlled my days. I didn't have to show up in an office or depend on the empathy of an employer. I had an income that could withstand the loss of earnings as I slowed my work pace down. I had health insurance. And at 48, one of the potentially tragic side effects of treatment, infertility, was not an issue for me. I am well aware that had I had a more advanced or more aggressive cancer, treatment would have been harsher and harder to bear. Some people suffer horribly, and for some there is no hope. During radiation, I shared a waiting room every weekday for six weeks with pediatric cases, geriatric cases, and people for whom the treatment was palliative, to ease their pain, without promise of cure.
But I can only speak from my own experience, and my experience tells me that the exaggerated fear we have of this disease and its treatment is unwarranted, and dangerous, because it keeps women from seeking potentially lifesaving care.
Of course, I know all this now. I did not know any of it on the day of my diagnosis. I stood in that hospital corridor, halfway to the phone booth, as the sum of all my years of cancer fear sped toward me. All those years, visiting someone in a maternity ward or an elective surgery department, I'd hurry past the signs pointing to ONCOLOGY, making some kind of modern version of the old medieval sign against the evil eye. I didn't know what went on in there; I didn't want to know. But now I was going to find out.
“Not, I'll not, carrion comfort, Despair, not feast on thee.” The line from Gerard Manley Hopkins's poem arrived unbidden. It had somehow unpacked itself from the mental closet of my high school English classes. Then my own more prosaic, slightly querulous inner voice started up: "You've always liked to think you're pretty tough," it instructed sternly. "Well, here's where you get to prove it." I turned the stalking shadow of fear back with the force of all my willpower. There would be no tears that day, or any day following. (Unless you count the day of my second surgery, when I made the mistake of watching Map of the Human Heart while I waited for my turn in the OR. When the orderlies finally came in to wheel me to the theater, I was boo-hoo-hooing my head off. They wouldn't believe I was crying over the movie's tragic story of unrequited Inuit love, and not my own predicament. After that, I made a new rule: Watch only comedies.)