Twisty Colored Cancer Ribbons for All!
Did you know that four percent of the U.S. population — one in 25 of us — are now "cancer survivors"? This I read in the current issue of Time magazine, whose cover story concerns what John Wayne called "the big C," its diagnosis and treatment. That means that twelve million of us are entitled to wear one of those twisty colored ribbons proclaiming defiance of cancer in one form or another.
I think I can count myself among the four percent. Back in March, at my annual check-up, my family doctor found enlarged lymph nodes in my neck. He sent me off to a local radiologist for a scan. Off I went, thinking of that scene in Terms of Endearment when Debra Winger's lymph nodes likewise engage a doctor's attention. I was thinking too, in my gloomy way, of the Black Death. That great medieval scourge was most likely bubonic plague, whose characteristic symptom was buboes — dramatically swollen lymph nodes.
My buboes were duly scanned and the results sent to my doctor. "It's likely some type of lymphoma," he said, looking grave. "We need more tests."
Like everyone else nowadays, on hearing a diagnosis I head for Google. Lymphoma, it turns out, comes in dozens of varieties, ranging from the "indolent" to the "aggressive." Those are the actual medical terms of art. In a doctor's mind, diseases have personalities just as much as — more than, I darkly suspect — patients do. I don't know how far they take this. Are there affable, flirtatious, sullen, and frivolous diseases? Consult your family physician.
Precisely which kind of lymphoma one has is determined by a decision tree of tests, each branching of the tree eliminating some possibilities. We soon got down to CLL, which is to say Chronic Lymphocytic Leukemia, which is not one condition but a family, with slothful and energetic members like the larger lymphoma clan. Googling it, CLL didn't seem too bad. Sure, it can kill you, but not in any very gruesome way.
My most pessimistic thought was in fact: "Well, I've got a Blighty One." Back in the trench warfare of World War One, a wound that was serious enough to get you shipped back to Britain — "Blighty" — while not being disabling or disfiguring in any permanent way, was much prized. Well, we all have to ship back to Man's Long Home sooner or later. Blessed is he who can slip away peacefully. Isn't leukemia the movie disease, the one that takes you out of this world in more or less your normal shape, without a lot of pain?
I can't say I mind the thought of death. I'm close to the allotted span; I've been round the world a couple of times, published a few books, raised a couple of decent kids, got a good life insurance policy for the Mrs. What's to bother about? — so long as it's not protracted and painful. A Blighty One? I'll take it.
Inquiries among medical friends modified the picture somewhat. For one thing, a failure of the immune system, which is what leukemia brings along with it, can let in all sorts of nasty stuff. I heard some rather-not-think stories about rampant blood blisters, lungs filling up with fluid, and the like. For another, nobody who dies in a hospital bed does so while writhing in agony. "They'll make sure you're pretty well doped up, whatever it is you've got," I was assured. Still, CLL sound less of a nightmare than, say, esophageal cancer, which is what poor Christopher Hitchens has, and in the final throes of which you simultaneously starve to death and choke to death. Yeah, I'll take it.
As family and friends got involved I learned, too, after a lifetime of blessedly excellent health, one of the darker facts about human nature.
Having a possibly-terminal illness puts one at the center of a drama: and there is, I think, for all of us an unhealthy but undeniable satisfaction — pleasure, even — in perceiving oneself to be the leading actor in a drama. "He wants to be the groom at every wedding and the corpse at every funeral," someone said of Theodore Roosevelt. Who doesn't?
However, a few decades' experience of life accustoms most of us to the understanding that we shall never get to play Hamlet. With luck we may understudy for Rosencrantz or Guildenstern, but a place at the very center of life's drama will not be vouchsafed to us.
Then comes the Doctor's thoughtful frown, the ambiguous test result, the calls from hospital and lab, and suddenly we're in the limelight. The valetudinarian impulse is easy to understand. For those of us not fated to win awards, prizes, fortunes, or elections, a life-threatening illness brings as much attention — as much of a taste of fame — as we shall ever get.
In the event it turned out my particular drama was not Hamlet after all; more like Much Ado About Nothing. By the time we got to the end of the decision tree it had emerged that my particular strain of CLL was the most diffident one. It wasn't even worth the trouble of giving me any treatment, said the oncologist. "We'll just watch it. Come see me every three months. But there's a good chance you'll die of old age."
Having watched both my parents die of old age, the thought crossed my mind that I would prefer to die of almost anything else, or at least of anything else in the Blighty One category. There didn't seem to be any point in saying this out loud, though, so I left, went home, took a couple of stiff drinks, and got on with some work.
The following week that big C cover story in Time appeared, further damping down my dreams of terminal drama. The proper name for my condition, I learned, may actually be "incidentaloma." The business of diagnosis and testing has, it turns out, a fractal quality to it: the more of it you do, the more stuff you see. It is entirely possible that after scanning and diagnostic techniques have advanced through a couple more generations of technology, we shall find that everyone has cancer.
All but some tiny percent of us will be told, as I was, that no treatment is required, only watchfulness. It sounds like a wonderfully undemanding jobs program for oncologists. The consolation for the rest of us will be that we shall all be entitled to wear twisty colored ribbons.