The Kafkaesque World of Cancer

I ran into my friend Alan in the gym on Monday.  As I have reported in a number of past posts, Alan has been battling tumors in both lungs that continue to baffle doctors.  At least one doctor predicted that he would be dead a year ago.  The fact that Alan was in the gym already signals that he is not your normal cancer patient.  He works out daily and follows a smart diet.  He refuses to gently into that good night, to quote one of the most memorable poems about dying.

Some large tumors were removed from one lung in recent surgery, but there are also tumors growing in his other lung that are far more difficult to operate on.  Different doctors have different theories about what should be done, with each recommending his or her particular specialty.  Nor is there agreement about the kind of cancer that Alan has.  Conflicting diagnoses have come in from time to time.

And then there is the health care system.  As we were talking, Alan got a phone call that he thought was from a doctor.  But instead it was a lab that was analyzing his latest biopsy.  They weren’t sure that they had the correct diagnosis and wanted to perform two more tests, at a cost of $4000 per test.  Alan’s insurance, however, would only pay for one test, not three.  If he paid for the two extra tests, would ambiguity be resolved?  That’s the promise but that hasn’t been the history.  Uncertainty, as has been the case throughout Alan’s illness, continues to pile upon uncertainty.

As we were talking, I said that Franz Kafka would have something to say about this and mentioned The Trial (1925).  In this nightmarish novel, K learns that he has committed a crime although he doesn’t know what this crime is.  He is shuttled from government office to government office during the process, never learning anything definitive.

Only at the end does he find certainty.  Two officials show up at his house, take him out to an abandoned quarry, and stab him in the heart.

In a book where virtually nothing has happened beyond K’s initial arrest, this ending is a total shocker.  Particularly disturbing is the fact that K feels shame for what is happening to him, despite the fact that he is guiltless.  Equally disturbing is the relief that he feels (and perhaps we the reader feel as well) that something definite is finally happening, even though that something definite is his own death.  Here’s the concluding paragraph:

But the hands of one of the gentleman were laid on K.’s throat, while the other pushed the knife deep into his heart and twisted it there, twice.  As his eyesight failed, K. saw the two gentlemen cheek by cheek, close in front of his face, watching the result. “Like a dog!” he said, it was as if the shame of it should outlive him.

Alan is no K and my admiration for him grows and grows as I watch him confronting his cancer.  He insists upon cross-examining doctors and of being treated as a human being.  He researches his illness, weighs options, calls upon friends with expertise.   At times his actions have caused doctors to back off of their original treatments as they realized they had their facts wrong (but they wouldn’t have known if Alan hadn’t insisted that test results be forwarded to them, which I’m learning does not always happen automatically).  His determination not to be a passive patient saved him at one point from misapplied chemotherapy.  Alan aims to be a partner in his own healing.

At the same time that he actively searches for a cure, he savors each day.  He is on the second volume of Proust’s In Search of Time Past (that’s a subject for another post).  He takes walks in nature and thrills to the seasons.  He has long conversations with his wife Jackie and with friends.  Twenty or so of us have been meeting with him twice a month in a salon we have established to talk about issues that we care about.  The past three salons have involved discussions about our parents.  Our next salon will be about “roads not taken.”

In other words, unlike K Alan refuses to die like a dog.  Looking at The Trialthrough the lens of Alan’s experience, I see is as a precautionary tale rather than as an inevitable reality.  For someone undergoing frustrating challenges, the novel might provide the comfort of seeing one’s situation articulated.  But Alan is demonstrating that the frustrations won’t necessarily get the last word.  Sooner or later his end will come, as it will for all of us, but he won’t roll over. 

Weather update: The threatened ice storm did not materialize although classes were not held Wednesday or Thursday.  I used some of the freed-up time to read Ralph Waldo Emerson’s 1836 essay “Nature.”  Here’s a passage that jumped out at me, both because of the snow and because of Alan’s intense interactions with nature: 

Not the sun or the summer alone, but every hour and season yields its tribute of delight; for every hour and change corresponds to and authorizes a different state of the mind, from breathless noon to grimmest midnight. . . Crossing a bare common, in snow puddles, at twilight, under a clouded sky, without having in my thoughts any occurrence of special good fortune, I have enjoyed a perfect exhilaration.  Almost I fear to think how glad I am.