I have not read much of what Christopher Hitchens wrote. I became most interested in him when he was diagnosed with cancer and began to write about his experience of diagnosis and treatment. After each article he published, I would wait eagerly for his next account. He validated my sense of disagreement about the language of the "Cancer Fight" when "taking" chemotherapy is a truly passive experience. He made it infinitely easier for me to be cranky and sarcastic and to speak my own truth. He made it easier for me to resist trying to make myself into, or compare myself with, the popular image of a Cancer patient.
It was also his writing that came to mind for me recently as I was re-reading an excerpt from a book about trauma that clarified for me, why some people with Cancer get PTSD. Aside from the obvious life threatening experience, you have few choices in treating cancer. You must submit to painful procedure after procedure, and in the world of Cancer, you are expected to smile while doing so. Be grateful for life, for the opportunity to submit to painful treatments, for the people who give you the painful but life saving treatments. You are left preferring the pain and discomfort over death. But in any other situation, you would never to choose to do any of this. Unless you are willing to choose death, it is surely out of your control. Cancer alone may give one PTSD, but Cancer treatment, at least the way it is often done, seems to make it much more likely that you will feel traumatized at the end.
I was and am so grateful for his contribution to articulating the awkwardness, absurdities and insults of Cancer and how the people around you deal with it differently. As Hitchens was not much known for his positivity, I did not look to him for this. I looked to him validate what I disliked, which made it easier for me to appreciate what I gained through my experience.
My two favorite pieces of his are pasted below.
Topic of Cancer
The author at home in Washington, D.C., July 18, 2010.
Ihave more than once in my time woken up feeling like death. But nothing prepared me for the early morning last June when I came to consciousness feeling as if I were actually shackled to my own corpse. The whole cave of my chest and thorax seemed to have been hollowed out and then refilled with slow-drying cement. I could faintly hear myself breathe but could not manage to inflate my lungs. My heart was beating either much too much or much too little. Any movement, however slight, required forethought and planning. It took strenuous effort for me to cross the room of my New York hotel and summon the emergency services. They arrived with great dispatch and behaved with immense courtesy and professionalism. I had the time to wonder why they needed so many boots and helmets and so much heavy backup equipment, but now that I view the scene in retrospect I see it as a very gentle and firm deportation, taking me from the country of the well across the stark frontier that marks off the land of malady. Within a few hours, having had to do quite a lot of emergency work on my heart and my lungs, the physicians at this sad border post had shown me a few other postcards from the interior and told me that my immediate next stop would have to be with an oncologist. Some kind of shadow was throwing itself across the negatives.
The previous evening, I had been launching my latest book at a successful event in New Haven. The night of the terrible morning, I was supposed to go on The Daily Show with Jon Stewart and then appear at a sold-out event at the 92nd Street Y, on the Upper East Side, in conversation with Salman Rushdie. My very short-lived campaign of denial took this form: I would not cancel these appearances or let down my friends or miss the chance of selling a stack of books. I managed to pull off both gigs without anyone noticing anything amiss, though I did vomit two times, with an extraordinary combination of accuracy, neatness, violence, and profusion, just before each show. This is what citizens of the sick country do while they are still hopelessly clinging to their old domicile.
The new land is quite welcoming in its way. Everybody smiles encouragingly and there appears to be absolutely no racism. A generally egalitarian spirit prevails, and those who run the place have obviously got where they are on merit and hard work. As against that, the humor is a touch feeble and repetitive, there seems to be almost no talk of sex, and the cuisine is the worst of any destination I have ever visited. The country has a language of its own—a lingua franca that manages to be both dull and difficult and that contains names like ondansetron, for anti-nausea medication—as well as some unsettling gestures that require a bit of getting used to. For example, an official met for the first time may abruptly sink his fingers into your neck. That’s how I discovered that my cancer had spread to my lymph nodes, and that one of these deformed beauties—located on my right clavicle, or collarbone—was big enough to be seen and felt. It’s not at all good when your cancer is “palpable” from the outside. Especially when, as at this stage, they didn’t even know where the primary source was. Carcinoma works cunningly from the inside out. Detection and treatment often work more slowly and gropingly, from the outside in. Many needles were sunk into my clavicle area—“Tissue is the issue” being a hot slogan in the local Tumorville tongue—and I was told the biopsy results might take a week.
Working back from the cancer-ridden squamous cells that these first results disclosed, it took rather longer than that to discover the disagreeable truth. The word “metastasized” was the one in the report that first caught my eye, and ear. The alien had colonized a bit of my lung as well as quite a bit of my lymph node. And its original base of operations was located—had been located for quite some time—in my esophagus. My father had died, and very swiftly, too, of cancer of the esophagus. He was 79. I am 61. In whatever kind of a “race” life may be, I have very abruptly become a finalist.
The notorious stage theory of Elisabeth Kübler-Ross, whereby one progresses from denial to rage through bargaining to depression and the eventual bliss of “acceptance,” hasn’t so far had much application in my case. In one way, I suppose, I have been “in denial” for some time, knowingly burning the candle at both ends and finding that it often gives a lovely light. But for precisely that reason, I can’t see myself smiting my brow with shock or hear myself whining about how it’s all so unfair: I have been taunting the Reaper into taking a free scythe in my direction and have now succumbed to something so predictable and banal that it bores even me. Rage would be beside the point for the same reason. Instead, I am badly oppressed by a gnawing sense of waste. I had real plans for my next decade and felt I’d worked hard enough to earn it. Will I really not live to see my children married? To watch the World Trade Center rise again? To read—if not indeed write—the obituaries of elderly villains like Henry Kissinger and Joseph Ratzinger? But I understand this sort of non-thinking for what it is: sentimentality and self-pity. Of course my book hit the best-seller list on the day that I received the grimmest of news bulletins, and for that matter the last flight I took as a healthy-feeling person (to a fine, big audience at the Chicago Book Fair) was the one that made me a million-miler on United Airlines, with a lifetime of free upgrades to look forward to. But irony is my business and I just can’t see any ironies here: would it be less poignant to get cancer on the day that my memoirs were remaindered as a box-office turkey, or that I was bounced from a coach-class flight and left on the tarmac? To the dumb question “Why me?” the cosmos barely bothers to return the reply: Why not?
The bargaining stage, though. Maybe there’s a loophole here. The oncology bargain is that, in return for at least the chance of a few more useful years, you agree to submit to chemotherapy and then, if you are lucky with that, to radiation or even surgery. So here’s the wager: you stick around for a bit, but in return we are going to need some things from you. These things may include your taste buds, your ability to concentrate, your ability to digest, and the hair on your head. This certainly appears to be a reasonable trade. Unfortunately, it also involves confronting one of the most appealing clichés in our language. You’ve heard it all right. People don’t have cancer: they are reported to be battling cancer. No well-wisher omits the combative image: You can beat this. It’s even in obituaries for cancer losers, as if one might reasonably say of someone that they died after a long and brave struggle with mortality. You don’t hear it about long-term sufferers from heart disease or kidney failure.
Myself, I love the imagery of struggle. I sometimes wish I were suffering in a good cause, or risking my life for the good of others, instead of just being a gravely endangered patient. Allow me to inform you, though, that when you sit in a room with a set of other finalists, and kindly people bring a huge transparent bag of poison and plug it into your arm, and you either read or don’t read a book while the venom sack gradually empties itself into your system, the image of the ardent soldier or revolutionary is the very last one that will occur to you. You feel swamped with passivity and impotence: dissolving in powerlessness like a sugar lump in water.
It’s quite something, this chemo-poison. It has caused me to lose about 14 pounds, though without making me feel any lighter. It has cleared up a vicious rash on my shins that no doctor could ever name, let alone cure. (Some venom, to get rid of those furious red dots without a struggle.) Let it please be this mean and ruthless with the alien and its spreading dead-zone colonies. But as against that, the death-dealing stuff and life-preserving stuff have also made me strangely neuter. I was fairly reconciled to the loss of my hair, which began to come out in the shower in the first two weeks of treatment, and which I saved in a plastic bag so that it could help fill a floating dam in the Gulf of Mexico. But I wasn’t quite prepared for the way that my razorblade would suddenly go slipping pointlessly down my face, meeting no stubble. Or for the way that my newly smooth upper lip would begin to look as if it had undergone electrolysis, causing me to look a bit too much like somebody’s maiden auntie. (The chest hair that was once the toast of two continents hasn’t yet wilted, but so much of it was shaved off for various hospital incisions that it’s a rather patchy affair.) I feel upsettingly de-natured. If Penélope Cruz were one of my nurses, I wouldn’t even notice. In the war against Thanatos, if we must term it a war, the immediate loss of Eros is a huge initial sacrifice.
These are my first raw reactions to being stricken. I am quietly resolved to resist bodily as best I can, even if only passively, and to seek the most advanced advice. My heart and blood pressure and many other registers are now strong again: indeed, it occurs to me that if I didn’t have such a stout constitution I might have led a much healthier life thus far. Against me is the blind, emotionless alien, cheered on by some who have long wished me ill. But on the side of my continued life is a group of brilliant and selfless physicians plus an astonishing number of prayer groups. On both of these I hope to write next time if—as my father invariably said—I am spared.
Miss Manners And the Big C
The author at home in Washington, D.C.
Ever since I was felled in mid-book tour this summer, I have adored and seized all chances to play catch-up and to keep as many engagements as I can. Debating and lecturing are part of the breath of life to me, and I take deep drafts whenever and wherever possible. I also truly enjoy the face time with you, dear reader, whether or not you bring a receipt for a shiny new copy of my memoirs. But here is what happened while I was waiting to sign copies at an event in Manhattan a few weeks ago. Picture, if you will, me sitting at my table, approached by a motherly-looking woman (a key constituent of my demographic):
She: I was so sorry to hear you had been ill.
Me: Thank you for saying so.
She: A cousin of mine had cancer.
Me: Oh, I am sorry to hear that.
She: [As the line of customers lengthens behind her.] Yes, in his liver.
Me: That’s never good.
She: But it went away, after the doctors had told him it was incurable.
Me: Well, that’s what we all want to hear.
She: [With those farther back in line now showing signs of impatience.] Yes. But then it came back, much worse than before.
Me: Oh, how dreadful.
She: And then he died. It was agonizing. Agonizing. Seemed to take him forever.
Me: [Beginning to search for words.] …
She: Of course, he was a lifelong homosexual.
Me: [Not quite finding the words, and not wishing to sound stupid by echoing “of course.”] …
She: And his whole immediate family disowned him. He died virtually alone.
Me: Well, I hardly know what to …
She: Anyway, I just wanted you to know that I understand exactly what you are going through.
This was a surprisingly exhausting encounter, without which I could easily have done. It made me wonder if perhaps there was room for a short handbook of cancer etiquette. This would apply to sufferers as well as to sympathizers. After all, I have hardly been reticent about my own malady. But nor do I walk around sporting a huge lapel button that reads: ask me about stage four metastasized esophageal cancer, and only about that. In truth, if you can’t bring me news about that and that alone, and about what happens when lymph nodes and lung may be involved, I am not all that interested or all that knowledgeable. One almost develops a kind of elitism about the uniqueness of one’s own personal disorder. So, if your own first- or secondhand tale is about some other organs, you might want to consider telling it sparingly, or at least more selectively. This suggestion applies whether the story is intensely depressing and lowering to the spirit—see above—or whether it is intended to convey uplift and optimism: “My grandmother was diagnosed with terminal melanoma of the G-spot and they just about gave up on her. But she hung in there and took huge doses of chemotherapy and radiation at the same time, and the last postcard we had was from her at the top of Mount Everest.” Once again, your narrative may fail to grip if you haven’t taken any care to find out how well or badly your audience member is faring (or feeling).
It’s normally agreed that the question “How are you?” doesn’t put you on your oath to give a full or honest answer. So when asked these days, I tend to say something cryptic like “A bit early to say.” (If it’s the wonderful staff at my oncology clinic who inquire, I sometimes go so far as to respond, “I seem to have cancer today.”) Nobody wants to be told about the countless minor horrors and humiliations that become facts of “life” when your body turns from being a friend to being a foe: the boring switch from chronic constipation to its sudden dramatic opposite; the equally nasty double cross of feeling acute hunger while fearing even the scent of food; the absolute misery of gut-wringing nausea on an utterly empty stomach; or the pathetic discovery that hair loss extends to the disappearance of the follicles in your nostrils, and thus to the childish and irritating phenomenon of a permanently runny nose. Sorry, but you did ask … It’s no fun to appreciate to the full the truth of the materialist proposition that I don’thave a body, I am a body.
But it’s not really possible to adopt a stance of “Don’t ask, don’t tell,” either. Like its original, this is a prescription for hypocrisy and double standards. Friends and relatives, obviously, don’t really have the option of not making kind inquiries. One way of trying to put them at their ease is to be as candid as possible and not to adopt any sort of euphemism or denial. So I get straight to the point and say what the odds are. The swiftest way of doing this is to note that the thing about Stage Four is that there is no such thing as Stage Five. Quite rightly, some people take me up on it. I recently had to accept that I wasn’t going to be able to attend my niece’s wedding, in my old hometown and former university in Oxford. This depressed me for more than one reason, and an especially close friend inquired, “Is it that you’re afraid you’ll never see England again?” As it happens he was exactly right to ask, and it had been precisely that which had been bothering me, but I was unreasonably shocked by his bluntness. I’ll do the facing of hard facts, thanks. Don’t you be doing it, too. And yet I had absolutely invited the question. Telling someone else, with deliberate realism, that once I’d had a few more scans and treatments I might be told by the doctors that things from now on could be mainly a matter of “management,” I again had the wind knocked out of me when she said, “Yes, I suppose a time comes when you have to consider letting go.” How true, and how crisp a summary of what I had just said myself. But again there was the unreasonable urge to have a kind of monopoly on, or a sort of veto over, what was actually sayable. Cancer victimhood contains a permanent temptation to be self-centered and even solipsistic.
So my proposed etiquette handbook would impose duties on me as well as upon those who say too much, or too little, in an attempt to cover the inevitable awkwardness in diplomatic relations between Tumortown and its neighbors. If you want an instance of exactly how not to be an envoy from the former, I would offer you both the book and the video of The Last Lecture. It would be in bad taste to say that this—a pre-recorded farewell by the late professor Randy Pausch—had “gone viral” on the Internet, but so it has. It should bear its own health warning: so sugary that you may need an insulin shot to withstand it. Pausch used to work for Disney and it shows. He includes a whole section in defense of cliché, not omitting: “Other than that, Mrs. Lincoln, how was the play?” The words “kid” or “childhood” and “dream” are employed as if for the very first time. (“Anyone who uses ‘childhood’ and ‘dream’ in the same sentence usually gets my attention.”) Pausch taught at Carnegie Mellon, but it’s the Dale Carnegie note that he likes to strike. (“Brick walls are there for a reason … to give us a chance to show how badly we want something.”) Of course, you don’t have to read Pausch’s book, but many students and colleagues did have to attend the lecture, at which Pausch did push-ups, showed home videos, mugged for the camera, and generally joshed his head off. It ought to be an offense to be excruciating and unfunny in circumstances where your audience is almost morally obliged to enthuse. This was as much an intrusion, in its way, as that of the relentless motherly persecutor with whom I began. As the populations of Tumortown and Wellville continue to swell and to “interact,” there’s a growing need for ground rules that prevent us from inflicting ourselves upon one another.