I visited cancerland in 1992, and now my wife is traveling there. I took the testicular tour, she is on the breast package. Her prognosis is excellent, as was mine. This piece is not about our particular experiences, but about the country itself.
Geography. Cancerland has many outposts in the city. Every Manhattanite knows where our great hospitals are; the far East Side is so thick with them you have to be wearing a stethoscope to hail a cab. But as treatments (and cases?) have proliferated, all of these institutions have spun off satellite offices — by the Mount Vernon Hotel, a 200-year-old stone building; over the entrance to the Midtown Tunnel; around the corner from National Review (a historic district for sure). The people ducking in that doorway you pass every day might not be ordinary Gothamites; they may be inhabitants of cancerland.
Population. Who are the inhabitants? Patients, of course. Then doctors. One thing the former must do with the latter is evaluate them before signing up for treatment. This is an anxious process, since doctors by definition know more than patients. Yet patients have to make a choice. A doctor who is too know-it-all may not in fact know enough; a doctor who is brusque or anomic maybe should be working with test tubes, not your innards. Get second opinions, compare and contrast, consult your gut.
Many of the city’s hospitals are teaching institutions, which means the first doctor you see on a first visit is likely to be a resident, getting his or her feet wet. Don’t hesitate to banish residents if they bumble. Learning is important, but no one has to learn on you.
A bad doctor can attract bad nurses and technicians, but generally the people in this tier of care-giving are saintly. Remember to thank them by name (that may also dispose them to move you up in the queue sometime).
How many of your friends will accompany you to cancerland? This turns out to be a strict test. Many come through with flying colors, some, from fear of death or pain or responsibility, flunk. Be sure you pass it when it’s your turn to be examined.
Rules and regulations. Cancerland runs on forms. GPs in black-and-white movies carried doctor bags; now they all have laptops or PCs for all the info they need to collect. The Health Insurance Portability and Accountability Act alone accounts for one flash drive. You are asked the same questions over and over again. Your answers — your medical history, your family’s medical history, your insurance provider — become a sing-song, like the Pledge of Allegiance.
Politics. Politics looms over cancerland, as over so many places. Leave aside the big issue of Obamacare. Every era has a disease that is the focus of fear and fascination. In many centuries it was the plague; in the 19th it was consumption. Now it is cancer. And these days, when medicine cures more people than it kills — when did that ratio tip? disturbingly recently, I bet — attention means research, expenditure, and progress. But within cancerland, some cancers are more popular than others. Breast is a winner, for many reasons. Feminism makes us remember the ladies; breasts are icons of maternity and sexuality. So there is a market for pink ribbons. What is the ribbon color for pancreatic cancer?
Manners. One of the minor arguments for religion is that it gives believers something appropriate to say to those who enter cancerland. “I will pray for you” is short and heartfelt. Not up there with the ontological proof, but noteworthy all the same. (But see also below.) Never appropriate are long accounts of acquaintances who died; long accounts of obscure alternative therapies; long worries about side effects, or the malice of insurance companies (the sufferer knows it better than you). Rarely appropriate are accounts of one’s own treatment. In a time of volunteer armies and sporadic peace, medical stories are our war stories. But unless yours contain specific tips, give them a rest.
For patients, news bulletins can be a draining experience. The e-mail urbi et orbi seems rude, yet how many times can you tell your story without feeling like Leno grinding out another monologue? Yet cancer can also empower. As my wife said, “If you have cancer, make cancerade.” She was trying to clear up minor medical business before radiation. Her eye doctor’s secretary gave her a song and dance about how there were no slots for a check-up. She played the cancer card, and bingo — read the fourth line please?
Resources. When you pause in the lobby of the hospital, and read on the wall the names of all the donors; when you consider the machinery that probes, records, and assays; when you reflect on the thought and imagination that went into so many aspects of treatment and cure, from the decision to administer radiation to women face-down so as to spare their hearts and lungs, to the discovery of different strategies for inhibiting the flow of estrogen to cancer cells — you add up all this money, time, effort, brainpower, and good will, and think, suppose this could have been applied to productivity? To beauty? So much genius, heroism, and hard work, spent on patch jobs.
Theodicy. And we need to patch because . . . ? The banker’s model of Christian salvation (we took out a whopping subprime mortgage, only Jesus can be our Fed), though painfully thin-looking and arbitrary from the outside, is clear enough on its own terms. Where does disease fit even on those terms? You expect Pol Pot from sinful man; do you expect cancer from sinful cells? You can make poetry out of the side-effects of the Fall (“So saying, with delight he snuffed the smell of mortal change on Earth” — Milton). You can’t make sense of them. We live in a world of random explosions whose maker says he’ll make it up some way or other. I wish him luck. Wish us the same.