and treatment.29
Race offers another way to parse the statistics. Overall, African Americans have more cancers, as well as higher mortality rates.30 Some researchers ascribe this difference to biology anchored in racial characteristics.31 Other studies find that once African Americans have access to screening, their cancer incidence and survival rates become comparable to those of whites.32 Such examples show that the categories used to collect data may be misleading if experts attribute disease patterns to race or age alone rather than considering access to healthcare or environmental factors.33
Risk does not deal fairly. Still, in some ways the risks of getting or dying from cancer can be measured against social status. Educational status matters more than race for absolute death rates. Less educated people are more likely to smoke (by a factor of three) and more likely to be obese. Whole groups of people, depending, say, on who might be eligible for spousal healthcare benefits or which jobs come with benefits, are excluded from healthcare coverage. One person I spoke with who was diagnosed with cancer at the age of thirty-three traces his symptoms back to when he was sixteen. However, as the son of a working-class single mother and then as a contract worker in the computer industry, he had no insurance until he got married at age thirty-three, three months before he collapsed in a subway station, which led, finally, to the diagnosis of his cancer. Minorities who have experienced, or interpreted, discrimination are less likely to visit doctors for checkups or to follow up on health concerns. One study found that nearly 80 percent of nurses did not want to touch their gay and lesbian patients.34 The Mautner Project, subtitled the National Lesbian Health Organization, finds that “lesbians are likely to receive substandard care, or remain silent about important health issues they fear may lead to stigmatization. . . . Lesbians may be one of the most medically underserved populations in the U.S.”35 Another study, one that used actors and scripts, found that given the exact same symptoms and age, women were less likely to be treated with the standard of care that men received, blacks less than whites, and black women were the least likely to receive medically indicated follow-up. This was true regardless of the race and gender of the doctor.36 Systematic discrimination is also disguised by the fact that the cost of medical insurance is the same no matter how actual care received measures against the standard of care.
The statistics, vast enough to argue for the significance of a researcher’s findings, or to claim a political agenda, also serve to shore up a notion of the disease—or the sum of the various diseases—that we implicitly agree to call cancer. The numbers create categories that might be inhabited and battled in terms of odds. Others have found more fluid ways to live with, and inside of, the new versions of time presented by the data. Often, this brings us to narrative.
IT MUST GO ON
Prognostic time demands that we adopt its viewpoint, one in which the conclusion haunts the story itself. Familiar dramatic narratives offer a pleasurable consummation. Knowing from the beginning how a Shakespeare play ends, we can anticipate that end throughout. By disclosing the eventual death of the protagonist in an opening scene of her play W;t, Margaret Edson offers the omniscient opportunity to witness Bearing’s journey into that experience. In this way, the play mimics other artifacts of cancer culture in which endings and beginnings are entwined. The clinical trial report states survival statistics, while the medical malpractice archive documents injuries and deaths. In these archives, the punch line of the future is dissipated, dissolved into the past—we know the end of the story even as we read it from the beginning. The temporality echoes the double action of prognosis: causing and evacuating the terror of a potentially limited future.
Vivian Bearing, W;t’s terminally ill English professor, offers a grammar, rather than a chart, for approaching death. She speaks about Donne’s Holy Sonnet VI: “Nothing but a breath—a comma—separates life from life everlasting. . . . Death is no longer something to act out on a stage, with exclamation points. It is a comma, a pause.”37 The pause indicates the blip between time lines—the one that leads toward an inevitable death, and the other in which there is no death. Amid all the ways to mark illness—the check boxes on forms, the numbers, the wigs, all the things that purport to carry meaning but can as easily occlude it—the comma, for Bearing, carries both significance and mystery equal to impending death. Punctuation provides comfort.
In Donne’s poem, where death merely interrupts two forms of life, punctuation provides the structure of inevitability and the means of mourning. But in its own ambition toward timelessness, it also provides the structure for the narrative of life passing into death through the meter of time and recitation.
Using the time-arresting medium of photography, Hannah Wilke, who died of lymphoma in 1993, challenges the viewer to ask related questions about destiny, the future, possibility, and inevitability. Wilke began her project of self-portraiture in the early 1960s, as her mother was dying of cancer, donning Greek robes and photographing herself in sensuous poses, or sticking chewed gum on herself and photographing it, perhaps offering a 1970s New York art-scene version of a Dutch vanitas painting. If Wilke’s early images reflect Western archetypal beauty, their meaning shifts dramatically in light of the two-decade series of images that ends with larger-than-life photographs of her middle-aged, positively not beautiful self in hospital gowns, receiving chemotherapy, and losing her hair.
The series of images comes full circle: Wilke foreshadowed the end at the beginning, when she juxtaposed her self-portrait with an image of her dying mother (fig. 3). The artist is young—youthful and white as a sixteenth-century Bronzino, her eyebrows plucked high and perfect; her stereotypical red-rose lips puckered with half a smile, triangulating the nipples of her breasts; her mass of dark hair tumbling around her head as if she were aroused. She looks directly at us. Audacious. Challenging. She reiterates a scene—an icon—a caricature.
Her mother, in contrast, looks down and across, as if toward Wilke’s right breast. That gaze triangulates the young Wilke’s right nipple and the mother’s vertical mastectomy scar, rutted against her dark skin with the cluster of red welts, which must be skin metastases, edging into the taut skeleton of her shoulder. The vivid color in the photograph—black, unkempt wig (surely?), reddened lips—hints at an ersatz health.
FIGURE 3. Hannah Wilke, Portrait of the Artist with Her Mother, Selma Butter, 1978–1981. Diptych, two cibachrome photographs, 40 × 30 inches each. Hannah Wilke Collection & Archive, Los Angeles © Marsie, Emanuelle, Damon and Andrew Scharlatt/Licensed by VAGA, New York, NY. Reprinted with permission.
Thirty years later, Wilke’s final, hyper-staged photos cite the Madonna theme again. In one she uses a pale blue hospital blanket as a shroud that covers both her bald, tilted head and her now sagging breasts (fig. 4). The depths of this image do not conceal a held child, however; the cancer legacy stops here. The photos together force the question: did Wilke foresee her cancer future?
From this vantage point, we can read the first photo only in light of the later one. We know what future they embodied: Wilke haunts us with a near-inevitability.38 But if her ironically posed grace in the Madonna photo shows the certainty of disease and death, it also iterates the mocking of time afforded by the medium of photography. Photography, as Roland Barthes theorizes, gives each of us a prognosis. A short time before he was killed by a truck as he left his classroom at the Sorbonne, Barthes wrote:
One day, leaving one of my classes, someone said to me with disdain, “You talk about Death very flatly.”—As if the horror of Death were not precisely its platitude! The horror is this: nothing to say about the death of one whom I love most [his mother], nothing to say about her photographs, which I contemplate without ever being able to get to the heart of it, to transform it. The “thought” I can have is that at the end of this first death, my own death is inscribed; between the two, nothing more than
