Survival odds and grammar offer various ways in which prognoses come to be made meaningful through the counting, recounting, and uncounting. As fragments, they also create partial knowledge and cast silhouettes that hide other tricks, as the subsequent chapters describe. The prognosis yokes the survivor to the past and future, but confusingly. The illness adage of “living in the moment” nearly entirely misses the point. Living-in-the-Moment may provide a small resistance to the march of time. But it also mystifies the ways in which daily newspapers, retirement savings plans, and pharmaceutical advertisements alike ask us—even require us—to live in prognosis out there in the wild world, walking before the firing squad. I am alive. No, you are dead.
CHAPTER 2
Poker Face
Gaming a Lifespan
When my partner’s sister showed up at our house all bald after her chemotherapy, I demonstrated my unvarnished social aptitude with the ridiculous joke, “Hey, you could totally be a lesbian!” I had picked up the culture of stigma, and this prevented me from genuinely recognizing her, even a few years later as she sat in a wheelchair shortly before her death. When my cousin Elise was undergoing chemotherapy treatment while in her early thirties, I couldn’t even mention cancer, couldn’t (wouldn’t, didn’t) say I was sorry or ask her how she was doing—even though it was so obviously what was going on. I was thirty-five, for God’s sake, a grown-up, yet cancer was so unthinkable that I couldn’t even acknowledge her disease. Whatever rationalizing spin I try to give it, I sucked in all the ways I had to deal with later when others made similar dumbish comments.
I don’t blame people for not knowing how to engage with a person with cancer. How would they? I obviously didn’t. Despite the fact that each year 72,000 Americans between the ages of fifteen and forty are diagnosed with the disease—double the incidence of thirty years ago—many of my friends in their thirties had no personal experience with cancer.
Everyone who has “battled,” “been touched by,” “survived,” “become a shadow of a former self,” or otherwise inhabited cancer clichés has been asked to live as a caricature. As poets recognize, clichés shut down meaning. These turns of phrase allow us not to think about what we are describing or hearing about. If we know roses are red and violets are blue, why would we bother to take a close look? News articles, TV shows, detection campaigns, patient pamphlets, high-tech protocol-driven treatments, hospital organizations, and everyday social interactions force people with cancer to live in and through these clichés. These venues overlap to form a broader network of ways we think, and refuse to think, about a revolting way to die.
I’m not opposed to social grace. A quick “You look good” followed by “Oh, thanks” offers a mutually welcome segue to the next discussion topic and enables propriety to mask the confusion about how disease should be acknowledged. It saves us from getting snot on a work shirt or accidently oversharing an existential crisis with a mere acquaintance. Still, the awkwardness—no, the devastating denial—contained in these conversations offers a window into the larger social confusion about how illness fits in with the broader economic and political infrastructures that contour American ideas, even ideologies, of a lifespan.
It’s no wonder shame is such a common response to diagnosis. As usual, the Oxford English Dictionary helps—shame: “the painful emotion arising from the consciousness of something dishonouring, ridiculous, or indecorous in one’s own conduct or circumstances . . . or of being in a situation which offends one’s sense of modesty or decency.” We know cancer will happen, yet when it does, it seems dishonoring or indecorous. I don’t refer to its side-effects here; the physical breakdown of the body virtually epitomizes “indecorousness.” Judgments about proper decorum (be a survivor, wear a wig, look good!) can help illuminate the ugly downside of America’s will to health.
My economic class, my age, and certainly my nationality buffered me from thinking about survival until I was suddenly the one who might be survived. Diagnosis beckoned me to attend retreats, camps, and support groups. Diagnosis made me share an infusion room—do all kinds of things, really—with many people who didn’t live for much longer. Diagnosis accompanied me in reading their obituaries, attending their memorial services, going to the garage sales of their things, writing on their memorial websites.
To be sure, diagnosis (as opposed to death or just plain old life) comes with its benefits. I got a kayak, albeit with a leak, as well as two weeks of adventure camp where I learned how to use it, all for free thanks to a group that offers young adult cancer “fighters” an experience designed to empower them to “climb, paddle, and surf beyond their diagnoses, defy their cancer, reclaim their lives and connect with others doing the same thing.”1 Even so, things can go bad. During down moments, I think about how at least my life insurance could pay for some cool things for my kids, or that maybe I don’t have to worry about saving for a down payment for a house, since in order for a home to be a good investment one should really plan to live in it for five years. I can look down from a superior place at all the people scurrying around on projects I have determined do not matter—and then go and do the laundry or shop for groceries just as everyone else does. Like Bette Davis’s character dying of a brain tumor in the 1939 movie Dark Victory, one can consider oneself the lucky one, not having to survive the deaths of those one loves.
(Sometimes one can’t help but devolve into a self-centered, unremitting fear. To ground myself in my ordinariness, I like to keep in mind what a driver once told me when I asked him what it was like to chauffeur celebrities such as Oprah Winfrey around New York. He fingered the St. Christopher amulet hanging from his rearview mirror and declared, “They like to think they are important. But after every funeral I’ve been to, people do the saaaaame thing. They eat.”)
The child survives the parent, the doctor survives the patient, the healthy survive the sick. But how have we come to take this mode of lifespan and survivorship for granted, as something to which we are entitled? Even a century ago, some—heck, many—of us would have died youngish, in childbirth or of some illness. Devastating though it may have been, people weren’t shocked. Even in the present, we don’t exactly live in medical nirvana. The United States is not in the top ten for the longevity of its population. According to some studies, it’s not even in the top forty.2 Yet despite such statistics, the United States spends more on healthcare than any other nation. Part of Americans’ dismal life expectancy results from the broad lack of access to healthcare as well as documented discrimination against the usual suspects: African Americans, women, younger people, and queers (not to mention those groups that remain not so well documented). Other factors affect even those with excellent access to excellent care: high levels of toxins in the environment, and in turn in human and animal bodies; cigarettes; guns; and little safety oversight of food, automobiles, and other products. Physician Peter Pronovost lists medical error after heart disease and cancer as the third largest killer in the United States.3
In short, despite the insistent rhetoric, American economies simply do not prioritize health. No particular logic demands that a population’s general health should trump other national concerns. So what do we get when we notice that it doesn’t?
The anxious dissonance between the bleak median state of health in America and the upper and middle classes’ general sense of entitlement to health and longevity plays out in the different, even contradictory, modes of time in which we each must live. On the one hand, lives correlate to a greater and lesser extent with a standardized, assumed timeline: birth; marriage; children; working, saving, paying taxes; kids’ college bills; retiring; dying. On the other hand, we have various links with immortal systems. The state, for example, underpins our expectations of a lifespan by helping some of us if we die early through various forms of financial aid to those it understands as legitimate dependents. In this sense, the immortal