8 June, 2009

The language of cancer

srilanka08-1151I had wanted to write this blog post a while back. But it seems that every new day during the past several weeks has brought with it yet another layer of meaning that, in its development, mirrors the layers of skin, tissue, musculature, nerves, blood vessels and so forth that are beyond my physical reach.

I’ve always subscribed to the “there’s a reason for everything” POV. Perhaps it is the Buddhist philosophy that has guided my life, or the culture of “what is to be done, this is how it is” that underlines life in Sri Lanka. A few months ago, I was cursing because a sprained ligament put an end to my dance classes, but it was that same toe that forced me to consult with a neighbor and find a doctor to call my own in a new town, a year after I’d moved here. And it was that doctor who brushed aside the usual excuses to insist that I get a mammogram.

The world reflects, in its quirky way, the things that are tipsy within us. I had to go back three times before I could get that mammogram. The first time I was a week early. The second time I did not have my paperwork. The third time I was lucky and I had a new friend behind the radiology desk at Lankenau Hospital. I had only had one mammogram before that one, and that several years ago, but some instinct must have told me all was not well; leaving those offices, I found myself rooted to the floor in front of the hospital cafe, gazing at sweet pastries and falling apart because I couldn’t think of a single friend near enough and unemployed enough to be available to have tea and cakes with me! And I think it was on my way back home that I met with the inconsequential accident that I talked about here, in a blog post titled Character.

Through the next week, when mammograms were compared and “the sort of pattern we don’t like” was discovered in dots and dashes that appeared like Morse Code on black film lit up from behind, and a biopsy ordered, I strode through my days full of the kind of humor that I always use to keep unpleasantness at bay, “If God was going to give me breast cancer,” I said, “couldn’t I have been given the mother of all breasts first?!” combined with upbeat equanimity, “well, I figure it’s either nothing or it is very early stage and something can be done about it.” It is also a way of postponing having to face up to difficulties, so much so that it wasn’t until I was standing in a shapeless double-gown (for modesty, apparently), and a radiologist with the unlikely name of Dr. Love, was explaining the procedure to come (stereotactic core-needle biopsy), that I felt like I was going to pass out. The guidelines say that “no significant pain” should be felt. But what exactly does that mean? I have always postponed the big howls because I imagine that the “big” pain is still to come, and I might as well not engage in premature melt downs; usually this means that I never get to have the big reaction because by the time I am well and truly ready to scream, it is all over.

Visiting with my surgeon soon after, I found myself alone in a room with a stack of glossy magazines which contained information about resources for people with cancer and their families. I picked it up and put it down. Nobody had told me I had cancer, and I was not about to acquire its accoutrements until someone did. Yes, said a friend, later that day, you don’t want to own it. But perhaps it was not bravado but hubris, the kind from which most mortals suffer, living with a subconscious belief in our immortality rather than accepting our daily march toward ceasing to exist in this particular life.

I was on my way out the door to make it to an NPR event with Marty Moss-Coane (Radio Times), when my cell phone rang in my hand. It was the good news, bad news call that I both had and hadn’t expected. It was cancer, or DCIS, which is like cancer’s calling card. Or is considered as such until surgery confirms or disproves that prognosis. I got off the phone and kept on going out that door, into the car and down the road to Bryn Mawr College where I was going to meet the host of a radio show I really liked.

I had determined then and there that I was not going to become Ru The Cancer Patient. If appointments there were, those appointments would be kept. The book tour would go on. I would fly to Chicago as planned. I can and would “work around” this hurdle. But determining such things is a lot easier than living them. Although I wrote brave emails to my agent, editors and publicists, not to mention my brothers, I could not escape the fragility that imbued everything and everybody around me. And late at night it was impossible not to be furious that nothing in my life has ever come easy.

Worse, still, was the fact that I appeared to be an individual with a personality and a way of looking at the world that was only apparent to me. I kept visiting hospitals where the vulnerable corporeal me would sit feigning strength and concentration, listening to my body being described in unfamiliar terms. But Ru the writer could not help but pay greater attention to the particularly hilarious language that was being used to do so.

She is a well-developed, well-nourished woman in no apparent distress…

I am not sure why it wasn’t apparent that I was in deep distress, or that frankly, my nourishment leaves much to be desired on most days. And I would not consider myself well-developed – witness the lack of the mother of all breasts!

She presents today with a recent abnormal mammogram. She denies any palpable masses…

But I have not spoken. And I am not living in the third person. I have a name. I am not a condition, or a case.

The DCIS appears to be contained, and has not left the ducts.

I picture dapper malignant cells, with black top hats and canes, sitting on wrought iron benches, tickets tucked into lapels, waiting for the next train to take them out of those ducts and into the rest of my body. I think of titles for short stories. I realize that all of this can be safely filed under Coping. But it is also my life as a writer that allows me to put the same safe distance between my spirit and my physicians as they have created between themselves and my body, all of us using language as our first tool of choice.

The surgery I don’t recall. I do recall the misery of yet another hapless pre-op nurse attempting to pierce my too-thin veins with their low-pressured blood. I have given up apologizing for the way my body carries me through the world with its barely-there affect holding up a high tempered heart. I recall the various barbarisms that are required before being wheeled in, still trying to be humorous, to an operating room where I fixate on the eyes I can see, kind, brown, calm, the voices that, thoughtfully, call me by my name.

I like my surgeon. She is warm, accessible, beautifully pregnant, and appropriately alive. She is not overly calm, nor unnaturally optimistic. She can say the words “survival rate” without making me panic. She can’t however offer me any reassurances that aren’t based on statistics and I am not a person who does well with needles or numbers. 80% of people who go through the stereotactic biopsy come through with a clean bill of health. I, unfortunately, belonged to the 20% that did not. 70% of those who go through surgery do not require additional surgery. Given the ease with which I crept into that previous minority, it is hard to imagine that I would be that lucky. But while I wait to hear, tomorrow, if all goes well, I continue to look for a narrative that can accompany me on the journey.

It is easy to flail at the blights that come into our lives, to say this or that is unfair, from the beetles that infest our roses to the cancers that invade our insides. I have done both those things. But there’s a part of me that realizes that I have no more right to exist than those cells that found in me, a permissible space. We lay down our roads and then curse the deer. We plant our flowers and then curse the insects. We create a lifestyle, and then curse our diseases. I do not know what particular toxin I poured in, or spiritual lack I became comfortable with might have caused my body to become habitable for a type of cell that nothing in my family or medical history or good-girl living could have predicted. Which is not to say that I believe I deserve to be going through this, but only that there is a reason for everything, whether or not I know what that reason might be.

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7 Responses to “The language of cancer”

  1. Barbara Casey says:

    Ru,what can I possibly say after you have said it so eloquently? Thinking of you and will help w/H or anything else you need. May tomorrow be.

  2. Mary Akers says:

    Thank you for this, Ru. Kind, honest, clever Ru.

  3. Sara Stowell says:

    Remember when I was singing across campus at you… Ru Ru se fue para el norte, no se cuando vendrá, vendrá para el cumpleaños, de nuestra soledad – Ru Ru left and has gone north, I don´t know when she´ll come back. She´ll come back for the anniversary of our solitude.

    There are things that are inexplicable, as you say, and their are people who go through them with aplomb, as you are, but there is no remedy for the solitude you must feel, in spite of our best intentions to let you know how much we love you.

    Holding my breath till tomorrow.


  4. cancer hats says:

    If you have cancer or think you have cancer ask your doctor about the BRCA test which tests a gene associated with hereditary cancer.

  5. Derek Bridges says:

    I’ve started and deleted this comment a few times because each attempt seems so small or trite, especially following your eloquence. I’m not one to pray so I’m left saying stuff like, “I’m thinking of you” [that’s no slight to Barbara above!] or “I’m pulling for you,” but those sentiments don’t come close to capturing what I want to express. I met you at Bread Loaf 4 years ago and you’ve been so kind to stay in touch with me, to be a friend, and I’ve been enriched by your intelligence and kindness, not to mention by your literary wizardry. Okay, I’ll go trite: I think the world of you and I desperately want you to be okay.

  6. Ru Freeman says:

    Derek – Your friendship and belief in me and my words – even when no words are being written! – is a real gift. I am through the surgery and the treatments and now on the long-term medications. There is a part of my psyche that will never be the same, but when I think of people like Tessa’s mother about whom I wrote the month before I found out I had cancer, I feel that gratitude should be the emotion to inform my days. Not that I don’t have bad days, but I do realize that in the midst of all these things that happen to us, there is much to be grateful for. Here’s that post – http://rufreeman.com/t/motherhood/

  7. Derek Bridges says:

    That’s a lovely post, Ru. You’re so right about gratitude–it should inform all of our days. I wish I didn’t have to be reminded of that fact.

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The Books:

The Books:

On Sal Mal Lane

In the tradition of In the Time of the Butterflies and The Kite Runner, a tender, evocative novel about the years leading up to the Sri Lankan civil war.

A Disobedient Girl

A Disobedient Girl is a compelling map of womanhood, its desires and loyalties, set against the backdrop of beautiful, politically turbulent, Sri Lanka.