The woman sitting next to me in the waiting room is wearing a blue dashiki, a sterile paper face mask to protect her from infection, and a black leather Oakland Raiders baseball cap. I look down at her brown, sandaled feet and see that her toenails are the color of green papaya, glossy and enameled.
This room at MD Anderson Cancer Center in Houston, Texas, is full of people of different ages, body types, skin colors, religious preferences, mother tongues, and cultural backgrounds. Standing along one wall, in work boots, denim overalls, and a hunter’s camouflage hat, is a white rancher in his forties. Nervously, he shifts from foot to foot, a styrofoam cup of coffee in his hand. An elderly Chinese couple sit side by side, silently studying their phones. The husband is watching a video. The wife is the sick one, pale and gaunt. Her head droops as if she is fighting sleep. An African American family occupies a corner. They are wearing church clothes; the older kids are supervising the younger ones while two grown women lean into their conversation and a man — fiftyish, in a gray sports coat — stares into space.
America, that old problem of yours? Racism? I have a cure for it: Get cancer. Come into these waiting rooms and clinics, the cold radiology units and the ICU cubicles. Take a walk down Leukemia Lane with a strange pain in your lower back and an uneasy sense of foreboding. Make an appointment for your CAT scan. Wonder what you are doing here among all these sick people: the retired telephone lineman, the grandmother, the junior-high-school soccer coach, the mother of three.
Show up early on Friday morning and lay your forearm on the padded armrest of the phlebotomist’s chair. Her nametag reads, NATASHA. She is clear-eyed and plump, and a pink plastic radio on her cubicle desk softly plays gospel at 8 AM. Her fingernails are two inches long, and it is hard to believe she can do her job with nails like that, but she’s flawless and slips the needle into the hardened, scarred vein in the back of your hand.
I wish there were other ways to cure your racism, America, but I don’t see one. Frankly your immune system seems to be the problem. Installed by history and maintained by privilege, it is too robust, too entrenched to be undone by anything less than disaster. That’s how it is for a lot of us. If you are white and doing well in America, a voice whispers to you incessantly, repeating that you deserve to be on top, that to profit is your just reward. And it’s not only white people who need the cancer cure; it’s any person who thinks that someone of another religion, color, or background is somehow not indisputably, equally human.
The first time you park your car in the vast, cold cavern of the underground garage and step onto the elevator, you may feel alien and forsaken. Perhaps you’ll feel that you have been singled out unfairly, plucked from your healthy life and cast into this cruel ordeal. Walking through the lobby with a manila envelope of X-rays under your arm and a folder of lab reports and notes from your previous doctor, you’ll sense the deep tremor of your animal fear, a barely audible uneasiness trickling up from somewhere inside you.
But there is good news, too. As you pass one hallway after another, looking for elevator B, you’ll see that this place is full of people — riding the escalators, reading books and magazines, checking their phones near the coffeepots. And it will dawn on you that most of these people have cancer. In fact, it seems as if the whole world has cancer. With relief and dismay you’ll realize, I’m not special. Everybody here has cancer. The withered old Jewish lefty newspaper editor. The Latino landscape contractor with the stone-roughened hands. The tough lesbian with the bleached-blond crew cut and the black leather jacket. And you will be cushioned and bolstered by the sheer number and variety of your fellows.
This strange country of cancer, it turns out, is the true democracy — one more real than the nation that lies outside these walls and more authentic than the lofty statements of politicians; a democracy more incontrovertible than platitudes or aspiration.
In the country of cancer everyone is simultaneously a have and a have-not. In this land no citizens are protected by property, job description, prestige, and pretensions; they are not even protected by their prejudices. Neither money nor education, greed nor ambition, can alter the facts. You are all simply cancer citizens, bargaining for more life.
It is true that this is not a country you ever planned to visit, much less move to. It is true that you may not have previously considered these people your compatriots. But now you have more in common with them than with your oldest childhood friends. You live together in the community of cancer.
More good news: now that you are sick, you have time to think. From this rocky promontory you can contemplate the long history of your choices, your mistakes, your good luck. You can think about race, too, because most of the people who care for you will be nonwhite, often from other countries. You may be too sick to talk, but you can watch them and learn. Your attention is made keen by need and by your intimate dependence upon these inexhaustibly kind strangers.
Two years ago I was diagnosed with cancer and underwent surgery followed by chemotherapy at MD Anderson. It was the start of my journey through this well-lit underworld. By now I have orbited many times around the honeycombed complex of registration desks, prep rooms, and staging areas, potted plants and bubbling aquariums. I have sat in the infusion lounge, where twenty IV poles rise like trees beside twenty upholstered recliners, each pole hung with a fat plastic udder feeding gemcitabine or cisplatin into someone’s arm: the unnaturally cheerful evangelist minister; the gray-faced Vietnam vet wearing his American Legion hat and windbreaker, as if he were going off to another war. We are not tourists in this place; we live here now.
In nothing but my hospital gown and cotton long johns, I have pushed my IV pole down the corridors at midnight, trying to keep my skinny legs from getting weaker. I’ve rolled my IV miles through the deserted hallways and empty waiting rooms, taken it over the sky bridge and back. Once, at 1 AM, I met a black guy doing the same thing. We paused and talked a bit, in our matching pale-green smocks, with our IV poles and drip bags. He explained to me, with a strange enthusiasm, that his doctors had cut out and then reversed his rectum, and now they would not discharge him until he could pass gas for himself. That’s why he was out walking so vigorously each night. As we stood there together on the wide, deserted walkway, it seemed as if cancer had erased our differences by bringing us into the intimacy of shared trouble. Then, with a nod, he strode swiftly away on his muscular legs, at least four times as fit as I was.
In the Republic of Cancer you might have your prejudices shattered. In the rooms of this great citadel, patients of one color are cared for by people of other colors. In elevators and operating theaters one accent meets another and — sometimes only after repetition — squeezes through the transom of comprehension. And when the nurse from the Philippines, or the aide from Houston’s Fifth Ward, or the tech named Dev says, “I’ll pray for you,” you are filled with gratitude for their compassion.
This place bears a passing resemblance to those old photographs of Ellis Island — so many travelers come from afar, sitting with their papers and passports, hunched on wooden benches with luggage at their feet, waiting to find out if they will be admitted and advanced to the next stage in the process. Some of the travelers are dressed in pajamas and slippers; some have on shiny blue tracksuits and Nikes; and some wear suits and ties, as if being presentable will make a difference. The shabby and the affluent, the stoical and the anxious, the scrawny and the stout, the young and the aged. If we are tense or pace restlessly, it is because we are aware that we may, on short notice, be swiftly deported. And because of this, perhaps, our hearts soften.
One awful night, after I’d made a scouring passage through the ER waiting room — room of heartbreak and harsh lighting — a smiling man from Nigeria named N’Dbusi entered my cubicle. I remember how he introduced himself, then reached out with his forefinger and thumb and gently plucked at my arm. Like a pleat in a piece of fabric, the skin stayed in a raised position. “You see this, my friend?” said N’Dbusi. “It seems you are dehydrated. We are going to give you some IV fluids to moisten you up.” He continued to talk with undiminishable cheer as his hands deftly removed the paper wrappers from a needle-and-tube kit and threaded the needle into my vein with the grace of a seamstress slipping a stitch into silk. He must have done this thousands of times. But where others might have grown bored and careless at the repetition, he had perfected an elegance.
This is the stupefying and ultimately transforming thing: that here, where I do not expect it, I encounter decency, patience, compassion, warmth, good humor. I remember the middle-aged nurse from Alabama, his calm Southern twang and beer belly, who stood firm one night, utterly unperturbed while I vomited repeatedly, as if a demon had seized control of my insides. With empathetic watchfulness, he administered the proper shot until I fell backward into a state of blessed relief. I remember the shift nurse with pale-olive skin and thick eyebrows who, in the middle of the night, brought me hot packs of damp folded towels heated in a microwave. She was from the Middle East, maybe Syria or Egypt. She was so kind and respectful to me that, after she departed, I abruptly burst into tears and blew her a kiss through the closed door.
The historical record — for tolerance, for human learning — is not promising. Yet I believe, more than ever, that at the bottom of each human being there is a reset button. Undeniably it is difficult to get to. To reach it seems to require that the ego be demolished by circumstance. But reach that button and press it, and the world might reshape itself.
Unfortunately you must come here, America. You must lie on the gurney and be wheeled down miles of corridor under a sheet, staring up at the perforated-tile ceiling and the fluorescent lights, not knowing quite where you are. You have to ride a wheelchair to your date with the MRI machine, past women and men being wheeled to similar destinations. You will look into faces lined with fatigue and pain and anxiety. Often a glance will pass between you: a glance without the slightest veil of disguise or pretense; a look of recognition and solidarity. It is a strange communion, but that is what it is.
I remember how the orderlies would wheel us along, calling out as they approached the intersections of corridors, “Coming around! Coming across!” in order to avoid collisions. I remember handsome Marvin, the mayor of the hallways, with his sleek cornrows, greeting everyone he met, his full voice singing, “Coming around, coming around! Coming across! Coming around!”
So, America, I express this rather unconventional wish for you: I hope you get cancer. In order to change, you must cross this threshold, enter a condition of helplessness, and experience the mysterious intimacy between the sick and their caregivers, between yourself and every person who is equally laid low.
Come into the fields and meadows of the examination rooms, come to the clean beds, to the infernal beeping of the monitors, to the lobbies and alcoves of this labyrinth. Look at the faces of the ones who are attending to you. Witness those who are silently passing by on their pilgrimage to surgery or radiology. Let the workers be fairly paid and valued, for their skills draw us together like the edges of a wound. Listen to the music of the voices around you. As the machines tick, as the ventilators suck and heave and exhale, as the very ground beneath our feet starts to dissolve, we shall be changed. Coming around, coming around, coming across, coming around.