Susan Gubar is a distinguished emerita professor of English at Indiana University and the author of “Memoir of a Debulked Woman,” which explores her experience with ovarian cancer.
Perhaps the concept of chronic cancer has been hard to comprehend because public discussion tends to focus on the initial diagnosis of breast cancer. Early detection of breast cancer yields good survival rates and many patients can consider themselves cured. Often we assume a clear-cut partition between survivors and the terminally ill.
In her book “Cancer Made Me a Shallower Person: A Memoir in Comics,” Miriam Engelberg divides a circle into two uneven segments to illustrate a divide in the breast cancer community. The larger part of the circle is labeled “Primary Diagnosis Only,” and a cartoon bubble exclaims, “I’m O.K. — Really!” The small section is labeled “Gone Metastatic,” with the caption “Damn!”
From the time she got her initial diagnosis in 2001 until her death in 2006, the same year her book was published, Ms. Engelberg resisted pressure to become “someone nobler and more courageous than I was.” She followed “the path of shallowness” by producing a series of droll comics on the “insanely cheerful” chemotherapy booklets and radiation technicians she encountered. She mocked her own self-absorption, trepidation and irritation as well as the social quandaries that arose as she, like her cartoon surrogate, plummeted from cancer survivor to terminal patient.
But for some of us, there is a middle stage in this journey. Because of advances in cancer research and the efforts of dedicated oncologists, a large population today deals with disease kept in abeyance. The cancer has returned and has been controlled, but it will never go away completely. Like me, these people cope with cancer that is treatable for some unforeseeable amount of time. Chronic cancer means you will die from it — unless you are first hit by the proverbial bus — but not now, not necessarily soon.
The word “chronic” resides between the category of cured and the category of terminal. It refers to disease that is not spreading, malignancy that can be arrested but not eradicated. At times, the term may seem incommensurate with repetitive and arduous regimens aimed at an (eventually) fatal disease. For unlike diabetes or asthma, cancer does not respond predictably to treatment.
Still, quite a few patients with some types of leukemia or lymphoma, prostate or ovarian cancer live for years. While in the 1970s 10 percent of women with metastatic breast cancer survived five or more years, today up to 40 percent do. Chronic disease may lack the drama of diagnosis and early treatment; even friends can get bored by mounting details. Its evolution does not conform to the feel-good stories of recovery that most of us want to read. But neither does it adhere to the frightfully degenerative plot of quickly advancing tumors.
On a number of websites, people with chronic cancer discuss the succession of therapies in which they enlist. When one drug fails, another combination of drugs begins. Complex dosing schedules, multiple tests and hospitalizations take their toll. No matter how grateful these patients are for their continuing existence, it requires not the spurt of sprinters but the stamina and sometimes the loneliness of long distance runners.
Ms. Engelberg’s “path of shallowness” can alleviate strain, especially from disabling byproducts of persistent maintenance: sadness, anxiety, anger and then remorse about all those roiling emotions. When repetitive and arduous regimens weary the spirit, it may be impossible to value the preciousness of life, to adopt a healthy lifestyle, to visualize one’s harmony with the universe, to attain loving kindness, to stay positive, to meditate to a state of mindfulness, to greet each day as a prized gift, to enlist the power of now. The social pressure to be upbeat can get anyone down.
The shallow path enables the cartoon character Miriam to circumvent the guilt trips induced by a gaggle of past and present cancer gurus. Instead of going inward, she often distracts herself: zoning out on “Judge Judy” or attaining “trivia nirvana” through crossword puzzles or joking about the need for a support group to cope with the jolly advice of her support group. Eventually she decides to make cartooning her “spiritual practice.”
If I am low during a yoga session, if the warrior, the goddess and the star feel impossibly strenuous, I take the shallow path with the supine pigeon and a revision of my wonderful instructor’s final words: “I am as whole, healed and healthy as I can be in this and every moment.”
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