Cancer: Our Collective Autobiography?

By Jane La Mantia de Pencier

There’s a book I’d been wanting to read for quite a while. I went to the bookstore to get it and picked it up. Then, I started wandering around and ended up buying a couple of books about beekeeping instead. Choices. Choices. Choices.

A Distant Mirror: The Calamitous 14th Century by Barbara W. Tuchman, I understand, was all the rage when it came out in 1978.

Well, I missed the rage, but today I hold it in my hands. There is much that’s interesting about it. Ms. Tuchman was very clear about her purpose in writing the book. She declares her intentions in the very first line.

“The genesis of this book was a desire to find out what were the effect on society of the most lethal disaster of recorded history – that is to say The Black Death of 1348-50, which killed an estimated one third of the population living between India and Iceland.”

Wow! The woman is really clear about her subject. The next thing that struck me as incredibly lucid is her method.

“I have chosen a particular person’s life as the vehicle of my narrative. Apart from human interest, this has the advantage of enforced adherence to reality.”

She goes on to explain this in more detail and it caused me to pause and think over her choice. I have to agree with the idea of biography, or a biographical approach, as illuminating if written in a way that encompasses the world around the subject and articulates the nuances well. What Ms. Tuchman did, with A Distant Mirror was to choose a person of distinction, but was for her purposes, mid-line. She chose what we might dub a representative citizen: a squire. Through this technique, she expected to be able to reveal the fine points of the age.

That made me reflect about self. It’s not so much that I was thinking about “I”, I was thinking, rather, about “We”. Who are we?

I think the most ordinary person of our age is either the cancer patient or the surviving loved one. I’m not sure which. I think a dichotomous narrative of time lived, post-diagnosis, would be incredibly revealing about the concerns of our day to day lives, our values and our larger society. Surely there must be other good examples of the ordinary person of our age: a high school student or a teacher, a white collar middle manager, a builder, a retail worker, an active environmentalist.

On the other hand, few high school students have much in common with builders and the middle manager and teacher live very differently in the typical weekday hour. An alternative common person might be the environmentalist, because after all, each of us live on this earth and will prosper or suffer under the follies of our consumptive habits. However, people debate this subject. So, the best example of our commonality is our humble physical selves. We all have bodies. We all can get sick. On the top of the charts, on the hit list of maladies, is cancer.

So the question now, is what can we learn about ourselves by reading the biography of our most common citizen? There are some historian’s pitfalls of which we should be conscious. Ms. Tuchman writes,

“A greater hazard built into the very nature of recorded history, is overload of the negative: the disproportionate survival of the bad side – of evil, misery, contention and harm.”

Ok, so in looking at the lives of our most representative citizens let’s be careful to try to look at them, completely, from a full 180 degrees. The sheer suffering and sorrow will be the easiest thing to see. Let’s look at other aspects of these lives that are common to us.

Hmm. Ok I’ll go first. I don’t have cancer. My immediate family members are, so far as we know, cancer free. I’ve lost a number of aunts and uncles and friends to cancer. There is something, I can say they all shared, besides the misery and the suffering. They were all incredibly noble as their lives ended and they showcased this nobility through a prism of bright wit. They were kind about their healthcare workers and they were hilarious about the indignities of their failing bodies. They just didn’t complain. Sometimes they got a little feisty, but that was the spirit in them. So far, that’s my biggest take-away in terms of their commonality. That’s incredibly positive, don’t you think? The other biggest commonality is that they left people behind who were not ready for their deaths, who felt surprised, shocked and ripped apart by the loss of their love.

The main thread in the cancer experience, of course, is the healthcare experience. What is the experience like for the patient and the families? Do they receive the kind of treatment that they think is appropriate, even if they could not be saved? Is there a satisfaction that our society’s healthcare promise is upheld? Either way, what does it say about our humanity? What does it say about our times? What is our healthcare promise?

Of the 14th Century, Ms. Tuchman is writing about a time much different from ours, but she maintains that certain historical truths hold. When there is a gap between the society’s principles and everyday life, a problem arises that demands to be addressed. Of those times, she talks about the institutions of order: the church, the king, the ranks of chivalry. She points to the ruling classes as really messing things up. Who are the ruling classes of our world, and more specifically of our healthcare world? Is there a gap between our principles and our experience?

The historian writes: “When the gap between the ideal and the real becomes too wide, the system breaks down. ....[and] “man retains his vision of order and resumes his search”.

The search for the ideal continues. The search in Tuchman’s terms downloaded into some real corruption and brutality like the bloody dismantling of fiefdoms, the gouging of various eyeballs and the bartering of immortality by the leaders of the church. That’s pretty serious. Well, I’m glad things aren’t this bleak. In fact, we live in a more collaborative age where there are no obvious evil squires and our expectations of collaboration are high and usually fulfilled. We live in an age where high expectations of personal and environmental health are reasonable. We have, however, seen a dark side. We do recognize that something is amiss. We are not healthy. Among other ailments, we are all getting cancer; a strange internal phenomenon of cell over-production. Now that’s metamorphic! Outside of the necessary environmental questions about cause, what do the commonalities of the healthcare experience and our dying tell us?

There must be something we can learn from our collective autobiography. Perhaps we could begin a conversation that attempts to come to the core of what is common in our cancer experience, and in so doing, gain a better understanding of our age, our character, and of any gaps between our principles and our reality. Who knows, maybe in writing our collective autobiography we will reveal something that until now, has been hidden from ourselves. Maybe we could learn about our healthcare experience too.

Copyright Jane La Mantia de Pencier, 2009