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FIGURE 4. Hannah Wilke, Intra-Venus Series #4, 1992–1993. Performalist self-portrait with Donald Goddard, chromogenic supergloss print, 47½ × 71½ inches. Courtesy Donald and Helen Goddard and Ronald Feldman Fine Arts, New York.
He can see it, but he can’t get at it. He has nothing to say; he can’t transform it. He can only wait. Here again, as with Bearing’s comma, the seeming timelessness of the photograph counters the time of life’s passage. Wilke’s images suggest that prognosis affects every dimension of time, not just the future; the past becomes equally mysterious and unknowable.
Lucy Grealy makes this point explicitly in her memoir Autobiography of a Face, capturing the eeriness of the past under life in prognosis, the sense of how her life’s truth and relevance might be “revealed” through diagnosis. Grealy was diagnosed with Ewing’s sarcoma in her jaw as a child and underwent years of harrowing surgeries that attempted to reconstruct her face, disfigured by radiation treatments, until she died of a drug overdose at age thirty-nine. Here, Grealy recalls a precancer childhood memory that becomes epiphanic after diagnosis:
As I sat there on the playground’s sticky asphalt I experienced time in a new way. . . . A year before, my class had gone on a field trip to a museum where I became fascinated with a medieval chart showing how women contained minute individuals, all perfectly formed and lined up like so many sardines in a can, just below their navels. What’s more, these individuals contained more minute versions of themselves, who in turn held even more. Our fates were already perfectly mapped out within us. . . . It’s impossible for me not to revisit this twenty-year-old playground scene and wonder why I didn’t go right when I should have gone left, or alternatively, see my movements as inexorable. If the cancer was already there, it would have been discovered eventually, though probably too late. . . . Sometimes it is as difficult to know what the past holds as it is to know the future, and just as an answer to a riddle seems so obvious once it is revealed, it seems curious to me now that I passed through all those early moments with no idea of their weight.40
Trying “to know what the past holds,” what alternatives and what necessities it contained, can become a near obsession when a person with advanced cancer faces the flimsy pages of a medical report. When a patient learns, for example, that her cancer, though present, was undetected in earlier tests and thus unannounced in earlier reports, this realization turns the faulty reports into the material remnants of lost opportunities—of times when treatments might have been less invasive, more efficacious.
No matter how far one’s cancer has spread, virtually everybody wishes they had been diagnosed sooner. At the retreats I attended, people talked about their alternative, possible pasts: the shame of not having done self-exams, of delaying tests because of being too busy, or of not wanting to ask more of already overworked people. Sharon said: “I wasn’t politicized enough and aware enough to ask.” Liz talked about the junctures when her doctors didn’t believe her reports about her symptoms. Not believing them herself, she decided to collect evidence of her yet undiagnosed leukemia herself, storing blood in her refrigerator and photographing it. Despite the action she took on her own behalf, regret and shame filled her memories: “How could I have just let it all happen, with all these signs—how could I have, you know, gone for my course in Toronto when I had to get up five times because I was bleeding so much?” Alice asked, “How could they have missed two tumors 11 cm and 10 cm that were fused together? On my CT scan they thought my tumor was my uterus.” Tina, a nurse, asked: “How could I have had so much trust—how could I have been so lackadaisical about my own health?” When she needed to book her surgery, her nurse-colleagues told her not to book it for the fall since they were short-staffed. So she delayed and later wondered, “I’m a nurse, for God’s sake. Why couldn’t I advocate for myself?” Here is Jennifer: “When doctors did not do exams, I did not want to ask them to touch my tits.” And Christine: “She told me I was too young to have cancer, and so we just watched it metastasize.” And Lynn: “I showed him the lump and he said since it is painful, it is not cancer.” Beth: “I don’t know why I didn’t insist. I guess I just didn’t know.”41
The “how could” discussions expressed a yearning for an alternative narrative that offered better odds. The women’s stories recalled moments, imagined crossroads—places at which a different action could have resulted in a different life. Despite the possibility of illness, well people, presumably, entered these life-altering junctures. Advocacy, diagnostic tests, trust—had my friends stayed well, they never would have given such things a second thought. Entering the nexus, not one of those women perceived herself as at risk for having cancer.
CONCLUSION
If I hadn’t been the “1 in 207” women who at my age have my stage and type of cancer, the rifle’s spray of statistics would have laid claim to someone else who didn’t do self-exams, whose physicians were careless, who delayed her medical checkup, who had no symptoms until it was too late, or who had no medical insurance. The stats don’t really care about that part. They at once describe and mask description. A single number implies both anyone (who could be the one with cancer) and everyone (in a culture and biology of cancer).
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
