"Fighting" cancer "bravely"

                Whenever anyone famous dies of cancer, it seems to me, there is always a headline or a newsreader who says the person “lost their battle with cancer” or died “after a brave battle with cancer.” This week, I saw at least one such headline on a news website about Joe Paterno, who died of lung cancer at the age of 85. Some days this type of battle metaphor for having cancer truly rubs me the wrong way. I am certainly not the first person to have this type of annoyance reaction. My daughter tells me that this very topic came up in a novel she just finished reading. But this week, the cancer-related battle language was annoying me so badly that I had to sit down and think about why it bugged me so much.

                Granted, there are times when the “warfare” language seems appropriate. Having cancer, at least the kind I’ve got, and the treatments that go with it, is a physical endurance challenge of a depth I’ve never experienced before. Maybe it is like warfare. I’ve never been in the military. I’ve never trained for a marathon or a prizefight. The only thing I can liken it to, from my own experience, is pregnancy.  I’ve been nine months pregnant. I’ve given birth. I would put the physical exertion of having cancer in that range of magnitude.

Maybe fighting in a war is like that. Or maybe fighting in a war is much worse. I would like to talk with a war veteran about this. I can see parallels. For sure, there is survivor guilt when you have had cancer and then you are told you are in remission, and you know there are friends of yours who aren’t. I am sure there are other psychological parallels, including post-traumatic stress disorder. (Also, I would like to ask if using too much of the “warfare” language for cancer annoys military veterans, for other reasons? Perhaps it cheapens the language for them?)

I’ve certainly used the warfare language right here in this blog. I’ve talked about tracking down cancer cells the way we’d like to track down Al Qaeda terrorists. I’ve told myself how “tough” I am. Thinking of myself as a tough little Montanan helped me get through chemo. I loved it when a friend nicknamed me “Captain Badass.” At my remission party, my daughter wore a pink shirt that read, “MY MOM KICKED CANCER’S ASS.”  Battle language, all of this.

My daughter enjoyed that shirt, and it was a proper moment for giddiness and celebration. But in the back of my mind, I doubted whether cancer felt as if its ass had been kicked.

Recently, at a cocktail party, a friend introduced me to someone as his “hero.” This made me very uncomfortable. Hero?  I hadn’t pulled anyone out of a burning house, or run through a firefight to save a platoon mate. I hadn’t even chosen the “fight.” It chose me. All I had done was not die yet. Okay, I have also tried to be honest and not whine a lot. I don’t think that staying alive and not whining a lot measure up to the criteria of “heroism.” I am not sure what he means by “hero.”

Is everyone who has cancer automatically “brave” and a “fighter?” Or do we just get credit for bravery because we happen to be in a situation that sucks? Or are we truly making some sort of distinction, here, when we say someone is fighting cancer “bravely,” and what we really mean is just that they aren’t whining a lot?

Several months ago, after I was first diagnosed with cancer, I crossed paths with a friend, who also has cancer. He had not seen me since my diagnosis. He gave me a big bear hug and said, “But we’re warriors, aren’t we?  We’re fighters, aren’t we?” and I hesitated. I was considering whether he and I are any more “fighters” than the next person with cancer is. He looked at me anxiously, wondering where my resolve had gone to, and I stammered that, just the day before, I had been called a “warrior princess.” He seemed comforted by that.

Here is my first big quibble with the military language:  If my friend and I are “fighters,” does that mean some people aren’t?  I have known a bunch of people with all different types of rotten cancer. Each of them was a fighter in their own way. Each of them tried, to the best of his or her ability, to stay alive.  I can’t think of a single person who just threw in the towel. But a bunch of them died anyway.

One reason I hate the warfare metaphor is that it encourages the idea that if only a person “fights” harder, more “bravely,” they won’t die. This is a lie. I know folks who were plenty brave who died anyway. I know people who absolutely used themselves up trying not to die, and they died anyway. Were they failures? Lousy soldiers?

A niece of a friend of mine died this summer of breast cancer. She was in her thirties. She left two preschool-aged children. She didn’t live near here, but I read her blog until I couldn’t bear to read it any more. Nobody I know wanted to be alive more than she did, because of her kids. Nobody I’ve ever heard of had more faith; she expected a miracle almost until the week she died. Nobody was braver. She went through treatments I don’t think I would have agreed to, trying to earn more time. All that, and she died anyway. Did she somehow fail? Come up short in the effort department, or in not wanting it enough? Surely not.

There’s a fallacy you often see in badly written TV shows on the Disney channel and such places. In these shows, children hear that they can be anything they want to be, if they want it badly enough and believe it hard enough.

Unfortunately, that’s not true.

It’s not true with cancer, either. And criticizing some cancer patients for not “fighting hard enough” strikes me as nonsense, except in unusual circumstances. It is the worst sort of blaming the victim. It really gets on my nerves when I see it in the news.

Another thing: having a “battle” implies there is someone on the other side you are battling with. But we aren’t talking about an evil force here, a demon or a malignant being. We are just talking about some of my own stupid cells dividing too fast. It’s like saying a diabetic person is having an argument with their pancreas. It’s silly, when you think about it.

In his novel, Little Big Man, Thomas Berger writes of a Cheyenne village that had been infected with cholera. “Those that wasn’t yet dying,” the narrator recalled, “got into battle dress, mounted their war ponies and challenged the invisible disease to come out and fight like a man.”

This image moves me. It seems so tragically misguided. But we do it all the time when we personify, or monsterify, cancer. I would have loved to challenge cancer to come out and fight like a man. After all, my kids wanted to see me kick its ass. That would have been pretty satisfying. But we’re only really talking about one of my own cellular-level bodily processes here, so the metaphor doesn’t really work, does it?

And then there’s a related problem: The idea of dying as “losing” a battle implies that somebody, somewhere, wins, or at least that winning is possible. But, in this life, every single one of us dies in the end. Nobody wins, ultimately. Nobody is supposed to.  Nobody has ever been so good at living that they didn’t die. Dying is part of the package. Dying is not failure at living. It’s just who we are. Battle language, on the other hand, implies there’s a winner. You win a war, or you lose it, or you draw, but it never just “is.”

And theoretically, on the field of military battle, most soldiers will make it through alive. There is some skill involved. Preparedness and hard work do count. That’s why soldiers train so hard: so they won’t die. And some of the soldiers who die do so because they or somebody else didn’t do their job well, because somebody was stupid, or careless, or cowardly.

It seems to me that dying of cancer in America these days usually isn’t like that. I am sure there are exceptions, when a doctor screws up or a patient ignores doctors’ orders. The skill of doctors and nurses, of course, makes a huge difference. And patients can manage their risks to the best of their ability, eat the right things and get the right amounts of exercise and sleep and take their meds properly. But a lot of those patients will die anyway. Usually, there is not a big medical screw-up or a failure of the patient to do what they’re told. Sometimes, you know, it is just not possible to live through cancer. Human bodies are inherently fragile and temporary. Death isn’t a moral failure. Maybe it’s a design flaw.

The problems of language surrounding death and cancer are part of our culture’s whole discomfort with the idea of death. We don’t accept it. We don’t plan for it well, some of us, anyway. We ignore it. We don’t talk about it well. Our rituals for dealing with it are not always the most satisfying. And we don’t like the randomness of illness and death. Wouldn’t it be nice if disciplined, “brave” people could fight off illness and death? We could then protect ourselves by just having a good attitude. If people died we would know why. It would be less random and less scary if we could demonstrate that it was your own fault if you died of cancer.

I suspect other cultures may handle the subject of death better than we do.

An illustration of what I mean can again be found in the novel Little Big Man, by Thomas Berger. The novel is the story of a white boy who was adopted by a Cheyenne man in the mid-1800s. At one point, there is going to be a battle between the Cheyenne and the whites, and the adoptive father takes his son aside and gives him a chance to excuse himself honorably from the fight, if he feels it is the wrong thing for him to be involved. The boy responds, “I think it is a good day to die.”

And explaining this statement, the narrator says,

“You tell that to an Indian, and he don’t immediately begin soothing you or telling you you’re wrong, that everything’s going to be swell, etc., for it ain’t the hollow speech it would be among whites. Nor is it suicidal, like somebody who takes the attitude that life has gone stale for him, so he’s going to throw it over. What it means is you will fight until you’re all used up. Far from being sour, life is so sweet you will live it to the hilt and be consumed by it.”

In that culture, death isn’t considered a personal failure, or unspeakably bad, or even the worst possible thing that could happen.

                If we in modern America could accept death as an inevitable part of life, not a moral failure or the worst thing in the world, it would have implications for day-to-day life. For a person like me, with cancer, it would have implications for questions such as when certain treatments might be not worth the damage to one’s quality of life, or when assisted suicide might be morally acceptable. Right now, it’s hard to even have those conversations; even the words we use, such as “assisted suicide,” are already loaded with so much baggage that we’d almost have to start from scratch, choosing a whole new set of terms that don’t come pre-filled with negative connotations. Is it still “suicide,” for example, if you are already dying?

                It would also have implications for how we talk to each other about death. I have friends who have been amazed that I would say out loud that I had thought I might be dying, and also that I would say this in front of my children. Mind you, I had already been so visibly sick that my children had begun wondering, for themselves, if I was dying. So to me, talking about it didn’t make the situation worse, and it potentially made it a lot better. But to some of my friends, talking about the possibility of dying was the worst thing I could do, short of dying itself. I was (very nicely) chastised by one person for saying I might not survive this illness. She seemed to think I was either being “negative” or melodramatic. I was merely trying to be honest. In any case, if it is this hard for us to even talk to each other about the possibility of approaching death—how do we figure out how to help each other through it, or ask for that help, if we can’t even say the words?

                So, friends: if I die of cancer, and if the death notice in the paper says she “Lost her battle with cancer,” I want you all to complain to the editor. And I don’t want anyone at my funeral saying, “She fought bravely.” Because really, who doesn’t?