The Problem With Cancer Memoirs

Popular accounts ignore the underlying race and class dynamics that determine vulnerability to the disease.

Margaret Garb

Marginalized people are more likely to get cancer and less likely to survive it. (Casey Hill Photo/Getty images)

I have spent many hours in a can­cer ward. It’s a spot­less, flu­o­res­cent-lit expanse divid­ed into pods,” a space-age ter­mi­nol­o­gy that is reas­sur­ing­ly high-tech. Inside each pod are rows of peo­ple sit­ting in Barcaloungers next to met­al IV frames dan­gling bags of flu­ids, like squishy Calder mobiles sus­pend­ed above the patients’ shoulders.

My frustration with Kalanithi’s memoir may lie with the genre itself. Memoir, by its nature, highlights the uniqueness of the writer’s experiences.

I usu­al­ly read a nov­el as the chemother­a­py drugs are infused. Most peo­ple are absorbed by their phones. Some sleep, some stare straight ahead, some chat with the chemo-bud­dies that social work­ers say can cheer you through sev­er­al hours of treat­ment. I have been in pods where one Barcalounger res­i­dent begins a con­ver­sa­tion with anoth­er — usu­al­ly the open­ing line is how long was your dri­ve,” and then what do you got,” mean­ing which can­cer— and then draws in the rest of the pod. There was the day two women, dis­cussing their pan­cre­at­ic can­cer, lift­ed their shirts to show us their ster­num-to-pelvis scars.

In the past few months, peo­ple in the can­cer ward have been car­ry­ing Paul Kalanithi’s high­ly acclaimed and beau­ti­ful­ly writ­ten mem­oir, When Breath Becomes Air, which was pub­lished posthu­mous­ly in Jan­u­ary and still sits atop best-sell­er lists. It has become a tal­is­man for can­cer suf­fer­ers and sur­vivors. Kalanithi was a 36-year-old neu­ro­sur­geon train­ing at Stan­ford when he was diag­nosed with stage 4 lung can­cer. He was the father of a tod­dler when he died in March 2015. Kalanithi had earned a master’s in Eng­lish lit­er­a­ture (with a the­sis on Walt Whit­man); it was lit­er­a­ture that sus­tained him dur­ing his most wretched days. With patients, and lat­er him­self, Kalanithi shies away from prog­no­sis — a two-month or five-year sur­vival rate — not­ing that sta­tis­tics say a lot about groups, but no one knows where an indi­vid­ual sits in a fog of numbers.

Indeed, my fel­low suf­fer­ers like to say that can­cer does not dis­crim­i­nate — its suf­fer­ers come in all shapes and sizes, races, class­es and incli­na­tions. Can­cer, at its sim­plest, is a group of dis­eases char­ac­ter­ized by the uncon­trolled growth of abnor­mal cells. The prob­lem is that the dis­ease lives in soci­ety. Some groups are more like­ly to be exposed to car­cino­gens, some are more like­ly to be killed by can­cer. Accord­ing to the Amer­i­can Can­cer Soci­ety, your chances of get­ting can­cer are greater if you live in Ken­tucky, Penn­syl­va­nia, New York, New Jer­sey, Con­necti­cut or New Hamp­shire. But you are more like­ly to die of can­cer if you live in West Vir­ginia, Ken­tucky, Ten­nessee, Alaba­ma, Mis­sis­sip­pi, Louisiana, Arkansas or Okla­homa — all in the top-ten poor­est states by medi­an house­hold income. African Amer­i­cans have the high­est death rate and short­est sur­vival rate from can­cer. In 2012, black Amer­i­can men were 24 per­cent more like­ly than white men to die of can­cer; the death rate for black women was 14 per­cent high­er than for white women. Racial dis­par­i­ties for some can­cers, par­tic­u­lar­ly breast can­cer, are increas­ing. Accord­ing to the Amer­i­can Can­cer Soci­ety, Social and eco­nom­ic dis­par­i­ties more than bio­log­i­cal dif­fer­ences” might explain the dif­fer­ing death rates. Can­cer — like jobs, edu­ca­tion, hous­ing and the crim­i­nal jus­tice sys­tem — does discriminate.

Even before his can­cer diag­no­sis, Kalanithi was a young man in search of mean­ing. He chose a career in med­i­cine to make a con­crete con­tri­bu­tion to human­i­ty. He chose brain surgery because the brain is where sci­ence and the spir­i­tu­al col­lide, where the inef­fa­ble stuff that makes each human an indi­vid­ual is formed. Life’s virtue, he writes, had some­thing to do with the depth of the rela­tion­ships we form.” He lived his phi­los­o­phy while prac­tic­ing med­i­cine. Here we are togeth­er,” he tells his patients. I promise to guide you, as best I can, to the oth­er side.”

Kalanithi’s courage in fac­ing death is remark­able. For some­one afflict­ed with can­cer, or any­one strug­gling with life, Kalanithi’s search and solu­tion — the find­ing of life’s mean­ing in every­day rela­tion­ships — is a sooth­ing balm.

Yet, the memoir’s broad appeal lies in its abil­i­ty to skirt a big chunk of cancer’s sto­ry. Kalanithi’s laser-like focus on each indi­vid­ual life leaves unex­am­ined the sources of the Amer­i­can Can­cer Soci­ety sta­tis­tics. It is com­fort­ing to think of can­cer as a bun­dle of mis­be­hav­ing cells and of health­care as an almost-friend­ship. But peo­ple, and health­care sys­tems, are social prod­ucts; we do not spring into being, can­cer-afflict­ed or not, in the puri­fied air of a hos­pi­tal room. Can­cer has been linked to pes­ti­cides in food, taint­ed urban water sys­tems and chem­i­cals in work­places, all under­gird­ed by the struc­tur­al forces of pover­ty and racism. Where and when you were born, your race, your nation­al­i­ty and your house­hold income influ­ence your pre­dis­po­si­tion to cancer.

My frus­tra­tion with Kalanithi’s mem­oir may lie with the genre itself. Mem­oir, by its nature, high­lights the unique­ness of the writer’s expe­ri­ences. (Bar­bara Ehrenreich’s bril­liant breast can­cer mem­oir, which evis­cer­at­ed the med­ical estab­lish­ment and self-help cul­ture, is an excep­tion.) Indi­vid­u­al­ism is a par­tic­u­lar attrac­tion of the can­cer mem­oir. We can­cer-afflict­ed like to believe our suf­fer­ing is unique, that we sit some­where just beyond the bell curve for prog­no­sis, and at the same time, that we have entered an egal­i­tar­i­an pod, shoot­ing for the stars.

But that is the kind of self-decep­tion that allows us to ignore the envi­ron­men­tal caus­es of can­cer, the bar­ri­ers posed by pover­ty and a cost­ly health­care sys­tem, and the sim­ple fact that pol­i­tics and soci­ety deter­mine that some peo­ple are more like­ly to die of the ill­ness than others. 

Mar­garet Garb is the author of Freedom’s Bal­lot: African Amer­i­can Polit­i­cal Strug­gles in Chica­go from Abo­li­tion to the Great Migra­tion.. She is work­ing on a his­to­ry of pover­ty and work in the U.S. from the Civ­il War to the Rea­gan era.
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