The World of Cancer

Opening \ Act I

This is how it starts. Michael wakes up one morning feeling something is wrong. He had difficulty swallowing a piece of carrot the night before and found himself kneeling at the nearest toilet bowl vomiting out tiny orange-tinged fragments. The act in itself was an enigma. He hadn’t vomited for over 20 years.

He goes to the doctor, who can’t tell him for sure what’s wrong. He’s sent for blood tests and an upper GI where a small mass is noted, but not identified. An additional test must be done which examines the digestive tract—an endoscopy. Michael knows nothing about his digestive tract or why he’s being directed by physicians to receive the specific tests. His wife, an RN, answers his questions, but doesn’t want to alarm him by giving him examples of what it might be. She doesn’t want to think about the symptoms and link them to the possible diagnosis, so she keeps the overwhelming thoughts to herself. 

The gastroenterologist doesn’t mince words when he gives Michael’s wife the results. “Your husband has esophageal cancer,” he said without looking her in the eyes. The wife wasn’t in a state of mind to believe the physician. She wanted proof: the biopsy results which wouldn’t be available until after the weekend. She took in the words for a matter of seconds then quickly dismissed them like a disobedient child.  All she could think about was how her husband might take the news when he woke up and how she might fix the problem.  

Act II

Results of a positive biopsy for esophageal cancer were received Monday morning. Michael now enters the world of cancer. Each time he is hospitalized for set-backs or procedures, he immerses himself into that cancer world—one that strips you of your identity and equips you with another one.

He is given an ID number, a bracelet which identifies him as a patient, and a blue pastel hospital gown. Some of his physicians and healthcare workers will remember his name and who he was prior to becoming a cancer patient, and others simply don’t care. His wife understands the medical maze, mainly because she’s a nurse and has witnessed it so often with patients, however family members and friends who don’t participate directly in his care won’t have a clue.

His chemotherapy room is an environment made sterile in order to protect his immune system from infection. Family and friends are told not to visit him if they are sick with a cold, flu, or any other disease which might be spread by coughing, sneezing, or touching.  Some listen and others ignore the warning, not wanting to be inconvenienced. So his relations with family and friends become reconfigured along with the rhythm of his days of treatment, work, and rest.

The effects on patients and families can differ. It can tighten relationships and it can pull others apart. The consequences of this disease is often a family rift which stems from a misunderstanding of the disease or a personal fear an individual has about disease, death, and dying. Or perhaps they fear being the next victim of this monstrous illness. That alone keeps them from being fully involved and entering the world of cancer.

Act III

Cancer has been a part of our world for years. By that I mean the care and management which has evolved over time along with the visibility and meanings of the disease. The ancient Egyptians knew about tumors that had a bad outcome, and the Greeks made a distinction between benign tumors and malignant ones. Ancient medical practitioners sometimes cut tumors out, but the prognosis was often grim.

There are basically three ways to treat cancer: you can cut it out surgically; you can burn it up with radiation; and you can poison it by suffusing the body with cytotoxic chemicals that knock out cancer cells along with some normal cells. This therapeutic triad can be combined in any number of ways. The fight is hard and ongoing—a battle against a poorly defined enemy.

In a perfect world, cancer is normalized as a manageable chronic condition. But reality is this: we live in a risk-factor world in which we all think of ourselves as precancerous, thinking cancer is in most of our futures. Our biggest concern: the specific type of cancer we might be diagnosed with. 

Closing \ Act IV  

Michael lived with his cancer for 760 days. During that time, some joined his world and others feared it. But he lived his last two years to the fullest and crammed a lifetime of memories into those 25 months. He understood the world of cancer and though he transitioned nicely into that realm, he played the game by the rules, hoping to win a full life and a reprieve from a hideous illness.  

With every story of death and dying, a favorable outcome seems to slip out somewhere between the darkness and the dawn. In Michael’s case, it’s the wisdom which he imparted on his family and friends about living, loving, and the world of cancer–a world that most of them knew little about. Thank you Michael for teaching everyone who knew you how to live in that world and how to die gracefully.