Kingdom of the Sick: Breast cancer and me

So, it has come. The switching of the passports. It is something wholly internal. On the outside everything is exactly as it was the moment before your diagnosis. But in a slow blink, you step into this other world where you no longer have plans, but hospital appointments.
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I felt a lump in my left breast in early August. It is difficult to find the word to describe that instant. Ricochet, maybe? There was the echo of an infinite array of women, who had all lived this moment, this touch, this gasp. There was recognition in the heartbeat when my fingers touched the skin, and it was unyielding.

A week later, I was on a biopsy table, and a week after that, was definitively diagnosed as hosting a carcinoma in my mammary. The worst of it was probably the two days immediately following the news that I needed a biopsy because of the “highly suspicious,” mass that the mammogram had detected. I cried a lot. I imagined the *worst*.

If I am honest there was some pleasure to be had in those moments of wallowing. Imagining other people’s eulogies about you is quite flattering. Or at least, it was in my imagination. “She was such a lovely person…great writer…good friend…” etc.

I suppose the reason for my overwrought reaction is the talismanic nature of cancer. It is not an illness as much as a metaphor for life’s deadly fragility. The weight of the word in the mouth, conjures bald heads and painful thinness and funerals.

But in the weeks that have followed, I feel the unwriterly need to reject metaphors. To name things for what they are. Ducts and tumours and cells and lesions; facts, not fear. I am not “fighting” cancer, because it is not a war. I am not “surviving” it, at least no more than every human alive is “surviving” life, the only certainty of which is death.
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Sontag wrote of cancer, “it’s not so much a disease of time as a pathology of space. Its principal metaphors refer to topography, (cancer "spreads" or "proliferates" or is "diffused"; tumors are surgically "excised"), and its most dreaded consequence, short of death, is the mutilation or amputation of part of the body. Cancer is notorious for attacking parts of the body (colon, bladder, rectum, breast, cervix, prostate, testicles) that are embarrassing to acknowledge. Having a tumor generally arouses some feelings of shame.”

I’m lucky to have been diagnosed decades after Sontag wrote this, when some of the tragic mystery that once infused the disease has been replaced by histopathology and gene-analysis. I have not felt any shame in being tumorous. But I have felt guilt.

I feel guilty telling others, because it makes them sad, or panicky. Family has their own moments of wallowing in worst-case scenarios. Friends feel sympathy yes, but also dread. If it could happen to Pallavi, they think, it could happen to me. Women silently add “get a mammography” to their mental to-do lists.

And then there is the fact that I am naturally a transparent person (this post being a case in point). When someone asks me, “how are things?” I reply, “fine, thanks,” because really neither the doorman at the nearby coffee shop, nor I, want an involved conversation about carcinomas. But it feels disingenuous. A lie.

I am not “fine.” I have cancer. The thought balloons up within me sometimes and chokes me with the need to protest the fakeness, when I have to present myself – in my writings or to a new acquaintance - as someone untouched by diagnoses and treatments.

But also, when it comes to those who do know, I often desire to discuss anything at all, except my cancer. The tumour recedes to a corner of my consciousness, when I’m enjoying Madrid’s fall weather, or debating Putin’s next moves, or biting into a truly exceptional baklava. Ask me what I’m writing about, not about cancer, I want to tell the overly solicitous.
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The edifice of modern medicine is pacifying. The hospital I go to is a private facility that specializes in cancer treatment. It reminds me somewhat of a small airport terminal. The registration front desk, down to the uniforms of the staff, is reminiscent of flight check-in. The nurses are like air hostesses, asking you take a seat, and the doctors are like pilots telling you not to worry, it’s just a bit of turbulence.

The place is always teeming. So many people with cancer: high society women and taciturn teenagers, the disoriented elderly and the tech bros who never seem to stop taking calls even as they are being wheeled away. Cancer patients are not a demographic, they are a microcosm of society.

These last few weeks, I’ve discovered just how cancerous the world is. Not a single person that I’ve shared my diagnosis with, has failed to tell me about an aunt, or mother, or best friend with the same disease. Others are “survivors” themselves, although I hadn’t known it.

It’s a pandemic, someone said to me. And indeed, one in seven women in the EU develop breast cancer at some point in their life.

(There were 1.18 lakh known cases of breast cancer in India as of 2016, the end date of the latest Global Burden of Disease study published in Lancet Oncology.)

During my initial meetings with doctors and technicians, I was always asked the same, odd-seeming, questions. The age that I got my period. The age that I had my first child. (This second question caused some unintended hilarity on the grounds of my imperfect Spanish. I thought I was being asked the age of my first child, rather than the age I gave birth to him. When I replied, “13”, it caused a little consternation until everyone figured out the miscommunication. Levity is always welcome in cancer.)

It turns out that getting your period before the age of 12 and having your first child after the age of 30 are both risk factors in developing breast cancer.[1] Who knew? I didn’t. Or maybe I did and had just filtered it out. There is only so much risk we can be alive to, in order to behave like we are living instead of dying – both of which happen to be true.

My prognosis has taken time in becoming clear, but in essence I am luckier than some, and unluckier than others. My cancer has not metastasized, but it is invasive. However, it is a type of invasive that responds well to treatment. They may even “cure” it, although that’s not a cancer word that most would use with confidence. Us tumour-carriers have treatment plans and survivorship (yuck) pathways.

But even if not “cured,” in the sense that we foolishly feel a cough is – that is until the next time it recurs- the knowledge of cancer, at least for me, has been absorbed into the body. It is no longer so granular, so present, so poky – but more diffused, like salt mixing with water. I often feel like I’m using my original passport to the kingdom of the well, or at least I’m getting quite good at switching between the two.

I am, however, yet to actually start treatments. My surgery, dear reader, is scheduled for mid-next week, and in the days that follow I will know whether and how much chemo I need.

As to how this will affect the Global Jigsaw and your kind subscriptions to it, my pre-treatment answer is: hopefully not much. Apriori, I don’t see why I can’t keep up the writing. If a particular week or three proves too onerous, I will try and run guest posts - so if any of you have any bright ideas that would fit this publication’s agenda: pitch me.

Lastly, I must apologise for this piece being tonally all over the place. That’s what getting sick, in an adult way, does to you. One moment you’re cracking cancer jokes with a friend, the next you are having a full-on breakdown while lying on a biopsy table with a needle stuck inside your breast.

But, lastly, lastly, the one question that has never occurred to me regarding the diagnosis, despite being a 46-year-old woman in reasonable health, is, “Why me?” Because the real question is, “Why not me?”
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Friends, hasta la proxima semana (ishallah!).

Please subscribe, share, comment, share etc. Hope this hasn’t made anyone sad. I’m not, most of the time, so don’t be. There is so much to wonder at in this Global Jigsaw of a world, like the origins of croissants, so research it!

This column was originally posted on substack on September 21.