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A hand in silhouette holds a cancer ribbon.

It’s been a few weeks now since The Tin Man, my 73-year-old brother and favorite golfing partner, learned that the source of his myriad aches and pains was an aggressive form of cancer. We’ve texted back and forth a couple of times since then, but the pandemic has ruled out in-person visits, and his paralyzed vocal cords make a phone call impractical. CaringBridge updates offer some news, but his true state of mind remains a mystery to me.

He’s a man of few words in the best of times, so I wasn’t surprised when he dubbed his first round of chemo simply “a new experience.” It left him confused, exhausted, and unstable, he admitted, but he awoke the next day feeling better. It’s been a hard road since then, according to reports from his daughter: nausea, pain, confusion. And radiation treatment has only just begun. I can’t even imagine what he’s going through.

And while pursuing something resembling genuine empathy, I find myself often distracted by questions of fate (Why him and not me?) along with an oddly disturbing sense of inevitability (How will I handle it when it’s my turn?). About six in 10 cancer diagnoses fall on folks my age and older, after all, so this doesn’t really qualify as paranoia.

That’s probably why Anne Boyer’s book The Undying recently caught my attention. The Kansas City–based poet and essayist was diagnosed with an aggressive form of breast cancer at the age of 41, and the book depicts her “oncology journey” in a way that helps me better understand what The Tin Man is facing now — and what I may also encounter at some point.

“To be declared with certainty ill while feeling with certainty fine,” she writes upon receiving her diagnosis, “is to fall on the hardness of language without being given even an hour of soft uncertainty in which to steady oneself with preemptive worry, aka now you don’t have a solution to a problem, now you have a specific name for a life breaking in two.”

A cancer diagnosis changes pretty much everything, Boyer explains. And though the oncology nurses do their best to burnish the process with faint optimistic signals, she knows she’s embarking on a very different voyage than the one advertised. “The nurses give me a glossy binder with a photo of a smiling silver-haired woman on its cover,” she notes. “The title is Your Oncology Journey, but I am certain that trip can’t be mine. Every step is on the road to Delphi, crowded with divination, every fortune now accompanied by the curse of it-could-be-worse, with the worst being even worse than that.”

I’ve long questioned the wisdom of a treatment protocol that involves injecting poisons into a body as a way of cleansing it of tumors, but Boyer’s depiction of her own chemotherapy experience may have hardened my views against even the most reasonable debate. The nurse administering the drug (Adriamycin) through the port in Boyer’s chest wears “an elaborate protective costume.” And for good reason: “The medicine destroys tissue if it escapes the veins: It is sometimes considered too dangerous to everyone and everything else to administer by drip. It is rumored, if spilled, to melt the linoleum on a clinic floor. For several days after the drug is administered, my body’s fluids will be toxic to other people and corrosive to my body’s own tissues.”

The irony, of course, is that the very drugs deployed to save her life make her feel as if she is dying. She can’t move, can’t eat, can’t work, can’t sleep. The treatment — as brutal as it may be — is administered only with her consent.

“There is a choice, of course, and you make it, but the choice never really feels like yours,” Boyer admits. “You comply out of fear of disappointing others, a fear of being seen as deserving of your suffering, a hope that you could again feel healthy, a fear that you will be blamed for your own dying, a hope that you can put it all behind you, a fear of being named as the person who cannot cheerfully submit to every form of self-preservative self-destruction written in the popular instructions.”

That sense of mandated submission, she adds, is a powerful force within the whole cancer-care ecosystem; it creates no-win situations. “Disobedience is dangerous,” she explains, “but so is going along.

“A patient must adopt a discipline of following instruction in order not to mess up the whole careful process, but doctors can be tired, imprecise, or even prejudiced and incorrigible. Nurses are mostly geniuses, but it feels dangerous to be obedient to doctors, some of whom don’t seem to know what they are doing.”

After four rounds of chemo that “effectively eliminated many parts of me,” Boyer reports, the tumor remained inviolate. Meanwhile, friends and family gradually drifted away, unable to handle the stress, the sorrow, the impending doom. She remained, for them, a static object — permanently frozen at the moment of the diagnosis. In some ways, this rendering of her by loved ones felt more painful than the disease.

“To yourself, who has not yet developed the consciousness required of your way of life as an object, the abandonment causes you to feel less human mostly in the manner of feeling entirely like an animal. . . . a sick and abandoned animal wishes to be anything in the world but that which was once loved and now is left alone.”

Still, Boyer considers herself lucky. She dumped her oncologist, sought a second opinion, and a controversial, aggressive treatment plan — featuring a double mastectomy and a fresh cocktail of drugs more disabling than she could’ve imagined — eventually eradicated the tumor. She greeted the news with mixed emotions, “like a baby being born into the hands of a body made only of the grand debt of love and rage.”

It’s the rage, however, that lingers: “If I live another 41 years to avenge what has happened it still won’t be enough.”

Boyer eventually comes to realize — as I hope The Tin Man and the rest of us will — that the disease and its treatment options offer nothing but uncertainty. It’s this capriciousness that makes every decision seem so frail, every prognosis so suspect.

“Cancer kills people, as does treatment, as does lack of treatment, and what anyone believes or feels has nothing to do with it,” she concludes. “I could hold every right idea, exhibit every virtue, do every good deed, and follow every institutional command and still die of breast cancer, or I could believe and do every wrong thing and still live.”

It’s all a crapshoot, in other words, a reality that makes total sense to me. But how do I tell that to the guy who’s rolling the dice?

Thoughts to share?

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