I don’t remember the exact moment when I stopped seeing chemotherapy as a sort of adventure, a necessary bit of healthcare after a breast-cancer diagnosis, through which I would do my best to be a good girl, bright and brave. Maybe it was when I first encountered the nurses wearing plastic smocks to protect them from what they injected into me. Or maybe it was when the nurse told my husband that for the first two days after chemo, I’d be so toxic that he’d have to wear a condom if we wanted to have sex.
At the start of my chemo, I had all my hair. I was lean and energetic. I jogged, hiked, biked, skied. The cancer clinic teemed with patients in various stages of hope, ruin, and resignation. During my first treatment, I chatted with bald and bewigged women who had the clinic pallor I would come to have, as if we reflected the pale sterility of the floors, furnishings, and icy-bright lights around us. I reclined beneath a steel IV tree that held translucent teats of Decadron, Aloxi, and Cytoxan as they dripped into me. I wheeled the tree around with me when maneuvering down the hall to the bathroom. I made jokes with the nurse who pushed two fat syringes of raspberry-tea-colored Adriamycin into my IV.
After that first treatment, I got up and left, as if I’d just had a flu shot or dental work. It’s over, my mother used to say to me after a visit to the dentist. You go out into the light of day, where people drive cars and listen to the radio and have lives. You go home and lie down, or think about making dinner, or try to comprehend the blurring urgencies of the evening news.
But the only thing that’s over is the infusion, that luscious noun, which sounds more like eating peaches than introducing poison into one’s veins. I had in fact begun a long, slow descent into a walled space of my body’s own making, far from the borders of living flesh.
Afloat on the misery of chemo, I was aware of everything and nothing. I made deals with vague mother figures; I begged my senses to dull. I felt keenly how mutable life is, and how humorless and indifferent the passage of time.
The nurses never jollied me up during my treatments. They had more-pressing concerns. For example, Adriamycin is a “vesicant,” which is an agent used in chemical warfare. When administering a vesicant, nurses must worry about “extravasation,” which means missing the vein and sending the Adriamycin under the skin. This simple error would cause tissue death and severe scarring. The nurses also worried that I would vomit and dehydrate, which would stall the Cytoxan in my bladder, a site known to be vulnerable to Cytoxan’s carcinogenic properties. Then there was the potential for anaphylactic shock and permanent heart-valve damage. So they weren’t too concerned about the ephemera of my moods.
I was too beaten up to feel outrage, so I floated, as if inside a deep well, down, down to the illnesses of my youth, where I used to watch the slant of the sun change over the course of a day, note when the refrigerator turned on and off. My mother would feed me cups of custard when I had the flu, and then pea soup and toasted cheese sandwiches as I started to get well. Surprisingly, the thought of food didn’t exacerbate my chemo nausea. For me, chemo nausea was a pure thing, a closed system: low, grinding, preoccupied with itself. When I received chemo, there was no question of my eating anything that day. Food and eating seemed like quaint customs of another country.
Cancer self-help books tell you not to blame yourself. It’s not your fault you got cancer, they say, even if you skipped that mammogram last year. But what if it is your fault? What if you drank too much, or drank at all, or smoked, or carried around twenty extra pounds you lacked the self-discipline to lose? What if you voted for a politician who greased the skids for polluting corporations? Aren’t we all liable somehow? Where does personal responsibility start? Don’t we want to teach responsibility to our kids?
Your kids, I mean. I don’t have kids. Oops — childlessness is a breast-cancer risk factor. So is early menses; mine came at age twelve. I grew up in Los Angeles under a blanket of summer smog so toxic that I’d come home wheezing at night. I lived in Bloomington, Indiana, for thirteen years under a cloud of particulates farted out by the university coal plant. For years I drank at least two glasses of wine a day, often more, with great pleasure.
Chemo suggests that, yes, it is your fault that you got cancer. Chemo feels like punishment. And it is punishment, aimed at cancer cells — which, of course, are my cells, part of me, little cretins I have created. Chemo is a death process designed to inoculate against death. Chemo is serious shit, and the whole body knows it. Everything within you writhes and protests. The niceness of nurses doesn’t fool the blood, the belly, or the bones. Nor does the cancer center’s kit of pink-ribbon items, which included, inexplicably, a credit-card-sized hand mirror, as if gazing at myself with no hair and no eyelashes would be something I’d want to do in the coming months. One becomes aware of the body as a community, and under chemo’s reign all the neighborhoods are stricken and bewildered. I had my worst round of chemo as Hurricane Katrina devastated New Orleans, and I experienced a grief-stricken kinship with the city. Each of my cells seemed to feel the levees break, and my guts resembled the blasted and contaminated Ninth Ward. I was almost grateful for the chaos I could see on the flickering screen. And then I wished us all whole again, as if what I wished for mattered.
The seasons went by, and I scarcely noticed. My chemo treatments spanned the change from summer to fall, and I perceived the leaves changing and the birds flying south from within a strange sort of absentia, as if it were all being narrated to me by a TV nature show.
How to prepare for chemo: clear the decks. No one tells you this, because no one wants to scare you. The chemo literature speaks of the hardy sort of victim that I did not turn out to be: “Many patients continue to work during treatment.” Of course, what’s left out is the many who don’t continue to work, who call in sick day after day or go on disability. We are a shadow workforce, lying on our sofas and beds, the work being done within us, as if our bodies were office buildings with the most frenzied sort of business taking place inside.
Before my cancer diagnosis, I had agreed to teach creative writing once a week for five weeks at a medium-security men’s federal prison. Partly out of pride, I decided to try to teach the class anyway, despite the bad timing: the class would end in the middle of my chemo treatments. I’d had to forfeit a semester-long college teaching job in another state — a job that I’d very much wanted — and I resented the incursion of cancer into my professional life. I was finding out that cancer is not very convenient.
My first prison class was postponed because of a lockdown, which punishes the entire inmate population for any dangerous altercation, no matter how few inmates were involved. Lockdown is a more restrictive level of confinement during which the men must stay in their ten-by-thirteen-foot cells — often with six men to a cell — twenty-four hours a day, their meals arriving at their cell doors.
Razor wire encircled the prison grounds, field after field of it radiating outward from the walls. A prison guard in a pickup truck drove the perimeter road beyond the razor wire, around and around, all day and all night. To get into the facility, I had to pass through a metal detector more sensitive than the ones used in airports. Then a guard rummaged through my purse and sniffed the contents of my water bottle. I had to have an escort at all times, though none of the guards had guns, which could be snatched away by an inmate. The prison’s regular employees had alarm devices instead, in case violence broke out.
It was hard to imagine the polite, well-scrubbed, attentive men in my class doing anything worse than running a stop sign, but from what I gathered about medium-security federal prisoners, I was likely to have bank robbers, kidnappers, and drug dealers in the room with me. There seemed to be an unwritten code that prevented me from asking the inmates about their offenses directly; indeed, one of the guards told me that some inmates hide their crimes from everyone, especially if what they did might provoke additional punishment from other inmates. So I didn’t ask, but I wondered. The Bureau of Prisons website could tell me the age, race, and release date of each man in my class, but nothing more. My student inmates often volunteered details of their lives and crimes, but it was they who controlled the release of that information.
Not so for me and my cancer. I had been able to conceal the effects of surgery; I was lucky enough to have escaped without a mastectomy. And I would finish the six weeks of daily radiation therapy with little more than a sunburn. But one oncology nurse told me that if I didn’t lose my hair to the Adriamycin and Cytoxan treatments, I’d be the first patient not to do so in her twenty years of nursing.
She was right, of course. After my second session of chemo, I could sense a strange sloughing off, my body shrinking away from itself. The first hair that started to fall was, interestingly, my pubic hair. When I shaved my legs and armpits, they didn’t grow back. The hair on my head grew dull at first, and then I was able to pluck out small fingerfuls of it neatly and easily. I kept pulling at it because I wanted to recognize the exact point of no return. When I reached that point, I planned to shave my head.
Nothing prepares you for losing your hair this way. The impact of it is something that even insurance companies understand. They equate hair loss with losing a limb and provide a “wig benefit.” Before cancer and chemo, I found this emphasis on hair a little hysterical, vain, and sexist — what, is a woman nothing without her hair? But when my pillow started to look like a dog bed and my hair came out in the shower in slippery, dark clots the size of Brillo pads, I understood it completely. One weekend my husband cut my hair as short as he could with office scissors over the bathroom sink, and then he shaved my head with his beard trimmer. We tossed the piles of hair out in the yard, where I hoped birds might harvest it for nesting material. Freed from my head, my hair was astonishingly voluminous. Tiny tumbleweeds of it blew around the yard for days.
Though I can be frank, I am essentially a private person. As a teacher I might share an anecdote from my life if it’s relevant, but I didn’t want to tell my students about my cancer. You can practically stop traffic by mentioning cancer in ordinary conversation, and the last thing I wanted my male student inmates to think about was my breasts. Pupils look at teachers’ bodies, always. The teacher’s body should be appealing but not erotic, which is why teachers usually wear nice, conventional clothing when they teach. This pleasant, neutral body helps establish the classroom as a safe place for the exchange of ideas. This fact was never more plain to me than during a certain lecture I attended in college. The professor, whom I liked very much, got up in front of about a hundred students and started lecturing with his fly down. Fortunately nothing poked through except his shirttail, but despite my fondness for him and his class, I could not look at him, and neither could anyone else. I learned nothing that day, although my professor did walk behind the lectern halfway through the lecture and emerge zipped up, much to everyone’s relief.
Yet I knew, on the Friday before my husband cut my hair, that the next week I would be utterly bald when I appeared before nine felons. And I was terrified of wigs. I dreaded the breeze that would blow a wig off or the tangling branch that would reveal all. So I decided to withstand the stares, particularly from children, who follow you with their eyes if you’re a bald woman, as if trying to figure out what species you are. I’m small-boned enough to look vaguely like an altar boy when bald, but no one took me for male. A heavy, rough-featured woman in my cancer clinic, mistaken many times for a man while bald, told me her story of heading for a women’s restroom in a restaurant when an employee stopped her, helpfully pointing her in the direction of the men’s room. Exasperated, she whipped out her large, naked breast and bellowed, “Does this look like a dick to you?”
Despite my wish to keep my cancer out of the classroom, I felt I owed the guys an advance warning. Personally, I wouldn’t appreciate a shock like that. Also, telling is a way of taking charge, just as not telling puts the inmates in a position of power over their own truths. So I told them everything: that I had breast cancer, that it was in my right breast, that I still had my breast, that I’d had a lumpectomy and now was in the middle of chemo, and that next week I’d be bald. I gave them a chance to consider me fully as a body and, specifically, a female body.
My classroom brimmed with testosterone. Most of the guys worked out, bulking up their arms and chests. Only one of them was over forty. During the class they spoke of the frustrations of prison life, and one man said, “I’d like to be building a bridge or something. Anything. Even a bridge to nowhere.” These were among the first people with whom I shared the most frightening, intimate thing that has ever happened to me.
I did it because I was hoping to preserve whatever teaching effectiveness I might have had up to that point. I did it in such detail because I refused to be shamed into silence by a disease of epidemic proportions that is probably caused by environmental factors left uncontrolled by our government. And I did it because, damn it, it’s lonely inside the cancerous body. I wanted these men to know me, and to know me at this point in my life was to know about breast cancer, or any cancer, which completely changes the life of the person who has it. After all, they trusted me; all teaching relationships have their basis in some level of trust. Why shouldn’t I trust them, my students, my felons? I was gambling that they hadn’t lost their humanity along with their freedom.
I told them shortly before I ended class, and I found myself unprepared for the depth of their response. To a man, my students’ eyes widened, and some cursed under their breath. After class was over, they came forward to shake my hand and offer their hopes and blessings. One student meditated every day, and he promised to include me in his daily declaration of good intentions. It seemed as if some barrier had fallen that I hadn’t known was there. In later weeks and months, I told a number of people about my cancer, but no one reacted with as much genuine pathos as those prisoners did.
The prison’s education coordinators attributed the success of the class to my bravery and stick-to-it good example. Maybe. But what I became more aware of as the class progressed was not so much that the men were impressed, but that they felt a kinship with me such as I’d never experienced with a class before.
My third chemo session, the most fearsome of the four I got, occurred the day after I finished teaching. It sank me to new depths of nausea and exhaustion. For the remaining month of chemo, I became a shut-in, moving from bed to sofa and back, day after day. Often I couldn’t manage even the shortest car trip — too nauseating. I had to decline one dinner invitation after another because I couldn’t eat, nor could I concentrate on more than one conversation at a time. Even then it had to be a short one.
In other words, I became confined. I think of the word confinement the way it used to describe how proper nineteenth-century ladies spent their pregnancies. Mine was an unchosen, unwanted confinement, during which I was visited with suffering and deprivation designed to make me better, to improve me. And the same is true of the confinement visited upon my felons. We constitute a nation on the fringe, a nation of people forced to endure privation and segregation while we sit out ordinary life on the sidelines. You might protest that my felons willfully committed crimes, whereas I was the victim here. You are a cancer victim, or a cancer survivor, both heroic designations intended to deflect responsibility away from you. But I did drink all that wine, despite the studies that linked it to breast cancer, despite the fact that both my mother and grandmother had had the disease. I did skip that mammogram the year before, the first one I’d missed in almost ten years. Doubtless my tumor would have shown up, perhaps at an earlier stage that wouldn’t have required chemo.
There’s a particular kind of relief in considering yourself to be the agent of your own misery. A 2006 New York Times article on breast cancer revealed that many women think they “know” why they got cancer: work stress; or a bad marriage; or too much candy, cigarettes, or alcohol. The article gave no indication of whether men take on the same sense of responsibility when they get cancer. Women have always served as a locus for vice. We eagerly take on blame, which gives us a sense of negative power. Better to have negative power than no power at all.
I don’t know if my student inmates are comforted by knowing that they’ve had a hand in creating their current difficulties. I do know they’re bitter about their lost time and about those friends and relatives who seem to have abandoned them. I know that at least one of them has appealed his conviction; no doubt others have as well. I understand the impulse perfectly. It’s like asking for a second opinion on a diagnosis, or running from one parent to another, only to get the same news from every quarter. Early in my cancer experience, I sometimes wanted just to get in my car and drive, so I could be in that promising whistle of space while chewing up the dull interstate scenery, not caring about destination.
My felons and I want out. Or maybe what we really want is in — back into the embrace of ordinary life. Of course, ordinary life has its disenchantments. In fact, I suspect that I drank all that wine to numb myself to what ordinary life fails to offer, or offers too abundantly. And when I read what my students wrote about life on the streets, in abusive families, in neighborhoods ruled by drug lords, I knew that their ordinary lives had failed them, too, and that they probably saw their crimes as adaptations to the cards fate had dealt them. But if we could, I think we’d all go back to our ordinary lives in a heartbeat, and try to see and do things differently.
My friend Arthur is tall, handsome, bright, fit, and successful. He’s an orthopedic surgeon with three kids and a beautiful wife, Peg, who’s my occasional running partner. One day Arthur turned up with stage II non-Hodgkin’s lymphoma. In the months of terrible chemo that followed, he said he took to obsessively checking the mail. “Why?” I asked. “I think I was waiting for a letter explaining it all,” he said.
I want a letter like that, too. If there’s a God, he needs to write me one. It had better be a long one, too, because he’s got more than cancer to explain. In his splendid natural history of predators, The Red Hourglass, Gordon Grice notes that the black widow spider’s venom is far more toxic than necessary to kill its prey. Moreover, there is little value in the black widow’s ability to kill large animals, who can easily retaliate with lethal force. “Evolution does sometimes produce such flowers of natural evil,” Grice observes. “No idea of the cosmos as elegant design accounts for the widow. No idea of a benevolent God can be completely comfortable in a widow’s world.”
Regardless of sociological theories explaining violence and poverty, and regardless of scientific theories linking cancer to too little soy, too much soy, smoking, promiscuity, or negative thinking, the element of chance defies the powers of reason and inquiry. Of all the abused and neglected children in New York City, why was one seven-year-old girl beaten to death by her mother? Of all the people who could have gotten cancer, why did it happen to my friend Arthur? If cancer happens to you, you will ask, as I did: Why me? “We want the world to be an ordered room,” Grice says. But there are flowers of natural evil, and unexplained goodness and glory, growing right across the road.
One of my student inmates planned to quit writing as soon as he finished the novel he was working on. “Why?” I asked. “You have talent.”
“Too hard,” he replied.
“Then what will you do?” I knew his sentence extended another twenty years.
He smiled and shrugged. “Practice yoga, and do time.”
In other words, within the confinement of his world’s particular manifestations, he will walk the road that lies before him. And I will walk my new road under cancer’s permanent mist, denuded of any unconscious notions I’d been harboring about a limitless future. Maybe recognizing the realities of confinement constitutes a sort of enlightenment. No matter who or what you are, the room still has four walls, the bottle holds the wine, and summer gives way to fall.