• Breast Cancer Awareness Month: Recommended Reading

    During Breast Cancer Awareness Month, some of us are getting screening mammograms, and others are celebrating a breast cancer survival benchmark, our own or someone else’s. Some of us are calculating our breast cancer risk and realizing that most women will never develop breast cancer, but some will. Some of us are wearing pink ribbons and are heartened by bus drivers and police officers in pink hats, and others are cringing at what’s been dubbed pink-washing of a serious health and healthcare issue. Some of us are following Julia Louis Dreyfus, who announced on Twitter at the end of last month that she has been diagnosed with breast cancer. It’s tough for even a healthy adult woman in the United States to avoid thinking about this disease as we make our ways through October each year.

    As for me, I’ve been reading some amazing books by women who have faced this disease and taken the time to put into words what breast cancer means in a real life.

    The Bright Hour was published earlier this year and was widely reviewed. The Washington Post called it “stunning,” and The Boston Globe called it “vivid, immediate.” Nina Riggs’s story and her beautiful sentences are those things. In my book Tumor, I talk about the language we use to discuss cancer — the battle, the territory, the journey — and Riggs strikes me as more eloquent than most of us can probably manage in such circumstances.

    When she was diagnosed with breast cancer, Riggs was only 37 years old and raising two young children. Breast cancer in younger women is more likely to be lethal, either in its initial aggressiveness or in later recurrence, than the same disease in older women. Like Riggs, I mapped out my cancer family tree, underwent genetic testing, and discovered I did not have any particularly quirky mutations that would put me at greater risk. Initially, Riggs’s MRI indicates one small spot, just as my mammogram indicated some tiny calcifications. But Riggs had what’s known as triple-negative breast cancer, whereas I had some abnormal but not cancerous cells removed. Riggs is initially told that her cancer is “highly curable,” and I sense optimism in her writing that carries through the book, as if she began writing this memoir when she had every reason to believe she would survive cancer and live a long time. That turned out not to be the case.

    Riggs decided early on after the diagnosis, “I have to love these days the same as any others.” After her mother’s death, Riggs admits to herself — and to us as readers — that her mother’s death and funeral are “some morbid test drive.” When something reminds us of our own mortality, we begin practicing, testing out the inevitability for ourselves. How do we adjust our lives, our priorities, our goals when we take our eventual death seriously? I read cancer memoirs, in part, as a test drive of my mortality, testing out options vicariously so that, if the time comes when I need to respond, I’ll have at least book learning from which to draw.

    After a dream later in her memoir, Riggs remains “haunted by what I am unable to feel.” Indeed, The Bright Hour allows me to consider how we decide — often unconsciously — what to feel and what to ignore as we go about our routine lives, healthy or not. Toward the end of the book, she writes, “I am trying to know myself. […] It’s hard: I am not done becoming me.” Ultimately, maybe none of us are ever done becoming. In fact, writing this book may have allowed Riggs to shape herself and her story, knowing she didn’t have the average lifespan for that task of making herself.

    I’m reminded of a much older memoir about breast cancer in which Audre Lorde writes, “My visions of a future I can create have been honed by the lessons of my limitations.” In The Cancer Journals, originally published in 1980, Lorde recounts her diagnosis and treatment through journal excerpts and commentary “to give form with honesty and precision to the pain faith labor and loving which this period in my life has translated into strength for me.” Diagnosed with breast cancer in her forties (and with liver cancer several years later), she talks about living “under the pressure of time” and “with the consciousness of death at my shoulder, not constantly, but often enough to leave a mark upon all of my life’s decisions and actions.”

    That’s not to romanticize a cancer diagnosis as necessary to appreciate life more fully. Lorde certainly confronts sadness, anger, and loss, particularly the loss via mastectomy. That said, like Riggs, Lorde was “writing to sort out for myself who I was and was becoming.” She considers the cancer and surgery “a gateway, however cruelly won, into the tapping and expansion of my own power and knowing.” Of course, a person does not require a cancer diagnosis to accomplish that. In fact, Lorde’s cancer story encourages all women to “live a considered life” in which we eschew nostalgia, evaluate our lives as they are, and discover and nurture our strength. In the end, she asserts, “I would never have chosen this path, but I am very glad to be who I am, here.” Both Riggs and Lorde come to know themselves more acutely.

    That’s not unlike the way Kelly Corrigan concludes The Middle Place, her own account of breast cancer at age 36. She realizes that we’ll all face bad news at some point and that we’ll need to rally around each other, through a cancer diagnosis or a friend’s death. She concludes, “We’ll transcend, Ladies. Because we did all this, in that worst moment, we will transcend.”

    I’m making connections across these books that may be tenuous, seeking likenesses in the ways these women talk about life and death. Some likenesses are overt. Both Corrigan and Riggs, for instance, have young children and also parents with cancer at the same time they are making that journey themselves. Yet, each of these memoirs is a very different take on breast cancer. Reading all of these books speaks to cancer as an individual experience.

    Corrigan lets a sense of humor come through in a way that Riggs and Lorde do not. Having survived her cancer, I wonder whether Corrigan had more room for lightheartedness than did Riggs. We are each differently humorous, though, and we likely each react differently to dire news, to nausea, to our needs. Corrigan isn’t nearly as funny as Miriam Engleberg in Cancer Made Me a Shallower Person, a memoir in comics that grew out of her experience with breast cancer at the age of 43.

    In her introduction, Engelberg admits, “They say hardship reveals one’s true character, and it was clear right away that I wouldn’t be the heroic type of cancer patient portrayed in so many television shows and movies.” Or in most other cancer memoirs, for that matter. Engelberg goes on to say, “When I was first diagnosed, I felt pressure to become someone different — someone nobler and more courageous than I was.” Again, the issue of becoming. While this observation contradicts Lorde’s encouragement toward power and strength, it echoes Lorde’s observation that “looking on the bright side is a euphemism” and that we should openly deal with what’s threatening.

    Engelberg openly deals with playing the cancer card, low libido induced by medication, and the “big gamble” of balancing risk and prudence as we guesstimate our individual life expectancy and how we might maximize it while enjoying ourselves.

    Like Corrigan, Engelberg opts to share cancer news via email. For both of these women, email correspondence is a way to maintain some control of communication and to share information with numerous people in a single effort. That’s the way my sister and I shared news when our mother was diagnosed with pancreatic cancer, so I have a sense of how crafted these missives can be in order to balance bad news and hope for the message’s recipients as much as the writer. In her message, Engelberg declares that she doesn’t want to talk about her metastatic development and signs it “Miriam Stay-Away-From-Me Engelberg.” I imagine this to be an exaggeration, but maybe not. Either way, humor can easily get lost in email, and, the next day, colleagues flee when they see her coming. Funny enough. The clincher is that, afterward, she turns to her friend and says, “That went well, don’t you think?” What a relief to not have to talk about one’s cancer, to not have to be as conscious as Lorde would have us aspire. Engelberg’s avoidance of interaction with others also reveals the effort those with cancer often put into helping those around them adjust.

    In fact, Engelberg has me thinking back to Nina Riggs. In “Symmetry,” a chapter in which Riggs picks out a breast prosthesis, she explains her physician’s opposition to breast reconstruction because it’s “a survivor issue” and Riggs is “not there yet.” My mother’s oncologist told my mother and me that we didn’t need to worry about long-term side effects of the medication she was taking. My mother knew she wouldn’t recover, but it hadn’t been laid out in quite those terms by the expert before. She would not live long enough to develop side effects. Riggs’s physician was telling her that breast reconstruction might not be worth it unless they knew she had a good shot at living long enough to enjoy reconstructed breasts. It’s a heartbreaking moment, but I may be projecting my own experience.

    In response to her physician’s words, Riggs writes merely, “It makes sense, but I really miss being symmetrical sometimes.” Riggs is not in denial; not yet being a survivor makes sense to her. Is she succumbing, though, to the nostalgia Lorde warns against, nostalgia for the body and life she had before cancer? Is the focus on symmetry instead of survival evidence of what Lorde sees as pressure to come to terms in secret and to help others adjust by appearing more normal? Just as Engelberg wasn’t ready to talk with colleagues about her advancing disease, perhaps Riggs wasn’t ready to talk with readers about not being a survivor.

    Ultimately, there is no single way to cope with breast cancer or to tell the breast cancer story. Riggs, Lorde, Corrigan, and Engelberg each have their own story, and the connections need not be comparisons. Of course, in the back of my mind, I am gauging ways I might respond were my own circumstances to change. Reading these women’s versions of their lives has given me profound respect for the different circumstances they faced, the different attitudes they embodied, and the different choices they made. Reading breast cancer memoirs is one way to see your way through the pink haze this month.