Jacob Brogan

The world is always ending

Anticipation: IV. Clean

            My thyroid came out clean. According to my surgeon, the cancerous nodule itself presented little difficulty. What’s more, there was no sign of the yellow fatty tissue that would indicate likely metastases beyond the organ. While she was operating, she noticed that one of the parathyroids – tiny adjacent glands that regulate calcium uptake – looked off. She removed it, but left the other three intact, left three when we only need half of one to function. A section of lymph came out too, as did the thyroid itself and its non-cancerous right nodule. Only this last bit of tissue presented any real resistance.

            My thyroid came out clean, but we do not yet know how clean it really was. On Friday, I will see my surgeon for what might be the final time. She and her clinical nurses will examine my neck, ensuring that it is healing properly. More importantly, though, they will tell me what the pathologists found when they examined the glands – thyroid and parathyroid – no longer my own. If I am lucky, this is the last any of us will speak of it. If I am not, if the cancer has spread after all, I will begin treatment by radioactive iodine soon after. One way or another, they will clean me out.

            When surgeons first began to remove tumors with regularity in the 19th century, they were puzzled by the recurrence of disease. Growths of the kind they had cut out reappeared without obvious reason, obviating their often dangerous work. As Siddhartha Mukherjee explains, it was only with careful long-term study that physicians came to understand biological facts we now take for granted. They discovered that new growths almost always sprang up along the perimeter of the surgical site. Cancer, even when it was easily operable, survived through cells that evaded the medical eye. It was not that the bodies of cancer survivors were predisposed to disease, as centuries of Galenian theory had suggested, but that they had never really been stripped of their diseases in the first place.

            Today, living as a cancer survivor means living with the possibility of relapse. We necessarily persist in a climate of anxious expectation, forever on the alert. That we do so is itself a scientific accomplishment, the consequence of those 19th and early 20th century longitudinal investigations. Our fear of cancer does not come to us naturally in the way of, say our fear of snakes. Before surgery, I was told that the global rate for the return of thyroid cancer after treatment is around twenty percent. This is already a pleasingly low number, but various factors make it lower still in my case, likely placing it in the single digits. How many thousands before me gave shape to these reassuring figures? Whose eyes ordered them into meaningful constellations? My knowledge of my disease is always already a biomedical knowledge. Accordingly, it is never quite my own. I was born beneath the sign of a scorpion? Why now the crab?

            Before I went under, my surgeon visited me just long enough to draw a line across my lower neck, dotted like Orion’s belt. Its significance was, of course, more functional than mythic: In a picture I took of it, only a cartoon diagram of scissors is missing. Cut here. Pull. Fold. Glue shut. Traces of those markings still linger, almost a week later, smudged in a way that extends the angry breadth of my gathering scar. The night after surgery, an apparitional doctor woke me to say that I should not be afraid of what I would see in the mirror. Some of the paint is still there. Your wound is smaller. Smaller than it looks. I cannot remember his face, but I hear these words each time I study my reflection.

            My thyroid came out clean, but my neck is still dirty. Look at it now and see flecks of gauze and black-grey adhesive stains. I am allowed to shower, allowed and I do. Allowed to shower, but not yet to let the water fall directly on my wound. It trickles down from my face as I shampoo my hair, neck washed and yet not washed clean. Like my knowledge of cancer, the surgical site is not entirely my own.

            My thyroid came out clean, but I did not. Not yet. The grime of both cancer and cure stay with me. Make no mistake: I do not, will not, live in fear of this thing, despite the distant possibility of its persistence or return. Still, it clings to my body, awaiting the warm water of a bath I cannot yet take.

           

 

            -July 13, 2014-July 21, 2014

            Seattle, WA and Washington, DC

Recovery Room

            Recovery room. The taste iron on my tongue.

            When I was young, I suffered from frequent nosebleeds. Too much capillary tissue, the doctors told us. Massed near the surface of the skin, my blood vessels would dry out, rupture. Eventually, you learn not to tilt your head back – as other people’s mothers were always telling me to do – but until then you grow familiar with the taste of your own blood. It has a metallic quality, like water fresh from a mineral spring. I didn’t find the flavor entirely unpleasant, though the school nurses always looked at me strangely when I told them so.

            At a museum in the Rockies, where the air was thin and dry, my nose began to bleed more powerfully than it ever had before. Six years old, I had insisted that we make our way up the mountains to examine dinosaur bones. We left not long after we arrived, my face covered with reddening tissue paper. This was the first time I felt that I was missing out because of something broken in my body. It would not be the last. I remember nothing about the museum except the lobby floor, cold marble that I studied as I shuffled out. Cold marble and the taste of iron on my tongue.

            I know now that I was detecting the presence of hemoglobin, a ferrous protein that carries oxygen through the blood. Hemoglobin travels from our lungs to our outer extremities, sparking cellular tissue into action as it goes. Learning of this process in high school, I was initially incredulous. Iron seemed fundamentally inorganic. How could it possibly be part of our bodies? Only the memory of that taste, rapidly oxidizing metal, convinced me that my teacher was telling the truth. In the flavor of my own blood, I glimpsed the first inklings of the scientific method, my taste buds the proving ground of a grotesque empiricism.

            What taste? The taste of iron on my tongue. I do not remember waking from surgery on Wednesday night. I remember my mother and Catherine by my hospital bed. I remember asking them the time. Then they are gone and I am coughing, hacking up not phlegm but my own blood. As someone clamps a breathing mask over my face, I am distantly aware that my oxygen uptake is perilously low. Still spasming, I see droplets of blood splattering the clear plastic of the mask. Convinced that I am drowning, I pull it from my face. At this point, I begin to hyperventilate and the timeline grows fuzzy. Eventually someone thinks to put a sedative into my IV drip. Drifting off, my breath regularizing, I think of the museum in Colorado, the thin mountain air, the taste of iron on my tongue.

            It wasn’t until the next morning that I was able to reconstruct what had happened. Awoken from the anesthesia, I had panicked at the feeling of a tube still inserted down my throat. Acting on pure instinct, I pulled it out myself, scratching my trachea and cutting the inside of my mouth in the process. I was not dying. There was no internal bleeding, no hematoma threatening to burst, just the superficial traces of my fear. When everyone had calmed down, the attending physician told my mother that “many young, athletic men” have the same response. Small comfort: A successful doctor thinks I’m young and athletic.

            The good news is that I can remember very little of this. I can still sense where the striations of the tubing raked the lining of my throat, but nothing of what it was like to yank it out. I recall little more than the wisp of a dream, snow falling on Washington, DC in July. Mostly, I’m left with the taste, not exactly comforting, but not unfamiliar either: Hemoglobin oxidizing in the mine of my mouth.

            Iron forms only in dying suns. It is the last thing they produce before they explode into supernovas. At first radioactive, it decays into something more stable, gradually gathers to form the crust of planets like our own. In cultivating the soil, we draw a little of that iron into ourselves. Sick, we spit it out again. As we do, we let extinguished stars caress our tongues.          

Anticipation: III. Lavender

            Ishaan’s lavender bloomed a month ago, maybe more. I call it Ishaan’s, but it precedes him, having taken root long before he rented the house. At night, the alley half-light washes out the dusty purple of its flowers. Seeking its shade, I sometimes reach out to break off a branch. I slide the stem through the unfastened buttonhole of my shirt (I am almost always more formal at Ishaan’s) to give myself something like a boutonnière. At the whim of a passing fancy, I play the part of the flâneur.

            Lavender is what we wish would linger. In my mother’s garden, where other plants grow, I read that it is better to cook with dried lavender flowers than fresh ones. I think of the way they hang, brown and pale. Lavender names a color; how remarkable that it becomes more fully itself as it grows less so. At my collar, the blossoms turn brittle as the stem slowly toughens. Nevertheless, it will still be there when I remove my shirt at the end of the night.

            Lavender is what will not linger. Picking my shirt off the floor in the morning, I can no longer detect the flowers’ subtle scent. Rub them between your fingers: They are not yet dry. Feel the way they crumble against your skin. What else remains? Just this, the tactile sensation of tiny petals particulating under pressure. For a moment, the smell returns, but it goes again as quickly as it appears.

            These days, I carry a sachet of dried lavender with me almost everywhere, carry it against a future of uncertain sensations, unknowable smells. It is a small thing, a linen pouch dyed pale blue with indigofera. My mother bought it for me when I complained that the lavender soap would not linger. I, in my turn, bought the soap in memory of a lavender ice cream that ice cream I ate once in Ithaca. It was imperfect, that ice cream, the syrup ill strained, but it stayed with me. Take me back to the creamery and I would have eaten it all.

            I love lavender because it does not linger. Cancer  lingers. We can only ever survive it, remain vigilant. Lavender haunts us, vanishes, blooms again. What do I anticipate? A color, a smell, a texture, a taste. Lavender. Just that.

Anticipation: II. Present, Tense

            Time moves differently for the sick, moves differently if it moves at all. When I have a cold, I sometimes convince myself that my health will never improve. My runny nose and my raspy throat cease to be symptoms. Instead, they become bodily facts, permanent side effects of life itself. Because it always hovers in the background, illness smooths over the arythmias of the everyday. No longer heterogeneous, moments slide into one another. The present, this present, persists endlessly.

            Oscar Wilde describes prison in similar terms. Writing from the Reading Gaol, he observes in “De Profundis,” “Suffering is one moment. We cannot divide it by seasons.” For the penitent Wilde, it is precisely the regularity of his situation that annuls temporal difference. Much the same is true for the ill, living as they do according to a stable schedule of medications and treatments. Wilde, however, imagines an end to his imprisonment. He spends long sections of “De Profundis” imagining what his life will be like after he is released, often indulging in reveries more Romantic than Victorian. One is only a prisoner so long as one is imprisoned. When the gates open, time resumes its ordinary erratic course. Cancer, by contrast, refuses to let us go. Must our time remain cancer’s time, our present cancer’s perpetual now?

            I heard from my doctor four weeks ago today. Four weeks with cancer, twenty eight days, a February’s worth of disease. Four weeks with cancer, but it hardly seems that time is passing. Unmet obligations surprise me each day. Apologizing, I beg distraction, but the truth is that I do not notice the hours slipping past. Only the act of writing clearly differentiates one day from the next. I contest cancer’s time not with the whir of my watch, but with the whisper of my pencil on the page.

            While writing offers some relief, it allows no absolute release. When I describe the past month, I inevitably do so in the present tense. In my prose, last weekend and the weekend before unfold as if they were simultaneous, as do yesterday and today. All experience has become experience of cancer, so all of it plays out in the same register. The effect is so totalizing that I worry I may annihilate myself in and through my own temporal syntax. Where the act of writing retextures time, the way I write threatens to sand it down once again.

            There is another possibility: Perhaps the present tense is a way of reclaiming my power, reclaiming it in relation to cancer. When I teach my students to write critically, I encourage them to discuss the texts they are analyzing in the present tense. They should not write that the Wilde of “De Profundis” “bemoaned” his conditions, but rather that he “bemoans” them. No arbitrary rule, this principle reminds us that our critical objects act every time we engage with them. They do whatever it is they do in the unending now of watching, looking, reading. The present tense acknowledges that art becomes meaningful through our interactions with it, not from some originary instance of creative invention.

            I would like to think that I narrate this month as I do in order to engage with my disease. When I began, I imagined that cancer and criticism could sit side by side. But as I write, I find that cancer – my experience of cancer – has become my critical object. In the pages of my notebook, cancer and I make time together.

            Questions linger: What tense will I employ after my surgery? What time will it be when I wake?

Anticipation: I. Sarah's Scar, My Neck

            Over brunch, Catherine points out a woman at another table, her neck bandaged just above the clavicle. What could her hidden wound mean? This stranger must have had her thyroid out, a realization that suddenly makes her a little less strange. Watching her out of the corner of my eye, I feel my lips parting, tongue curling to form words. My feet will not carry me to her. My questions go unasked. Instead, I study her bandage. It is a small thing, so grey it is almost invisible against her pale skin. I had imagined mine would be larger. I’m sure it will be at first. I’m sure it will shrink as it grows more familiar.

            Later, I ask Sarah to show me her scar. It was Sarah I told first when I learned I had Hashimoto’s disease, Sarah who first told me everything would be fine. Her own thyroid had come out when she was young, a caution against a precancerous growth. She has always gone before me; I look to her body for signs of what is to come. Today, she cranes back her head obligingly, pulls at her collar. For a moment, there is nothing to see. Closer inspection reveals little more than a slight indentation in the middle of a circle of slightly different shade. Not nothing, but almost so, a miniscule divot in the smooth topography of her neck. This is the sole mark of a procedure performed half a lifetime ago, the mark of an excision I never noticed in the eight years I have known her.

            Scars are memories made flesh. As with most memories, there is a stillness to them. We recall the edge of the blade, but not the arc it traced through the air. How strange, then, that our scars sometimes slip away. Objects at rest remain at rest, but stillness itself does not entail stasis. The absence of a scar might suggest good health, but instead it implies amnesia, an injury all the more profound for its invisibility.

            I ask Sarah to show me her scar because I want to know what to expect. Attempting to anticipate my coming discomfort, I am surprised to find no mark of hers on her body. This should comfort me, but instead it confuses. I know I will not emerge unscathed. I know there will be a line, a line that I will follow with my fingers in unconscious recollection. With its tactile tracings, my surgery will fold its way into my sense of self, a perpetual reminder that I had cancer, and that I have it no longer.

           Sarah’s scar might have offered me some visible image of this eventuality. Instead, I stare at a sheet of paper from which the words have been erased, a white expanse that bares only the vaguest indication of the meanings it once proffered. If surgery is speech then scars are the writing that secures its persistence. As I look at Sarah’s neck, I struggle to guess what my procedure will signify. She is no Sibyl and neither am I. Neither of us know what these leaves might sign.

           Sarah’s scar lends me no memories of my neck’s future. I will have to wait: Wait for Wednesday, wait through the weeks that follow. This time is insistently my own. It is nothing more and nothing less than the time that is passing.

           At the airport, I ask Catherine to photograph my neck. When the bandages shrink, when we pull them away, I want to remember my body as it has been, as it is now. No scar can hold these final moments in place.

my neck

Sorrow: IV. Synchronic

            Time is the medium in which sorrow swims.

            It takes me almost three weeks to feel the real emotional weight of cancer. Somewhere between towns, in a remodeled central New York barn, I sob quietly while my friends make music. Ask me why and I couldn’t tell you. Try to console me and I would brush you away. Maybe it’s the way weeks are piling up, the fact of cancer accumulating. In the first days after my diagnosis, I merely had cancer. Three weeks in, I have been living with it. What a difference the present perfect makes.

            A colleague notes the strangeness of my situation: When she was diagnosed with leukemia, the doctors went to work immediately. She was in treatment for months, still is now, but there was no hesitation, no time to breathe, no time to think. Precisely because my disease is so much less deadly than hers, I have been asked to sit with it. As my care has been put on hold, so too have I put much of my life on hold. Yet the hours still pass, unstilled. They seep into my pores and I grow heavy, my reservoir swelling. Crying, I let accumulated feeling trickle out, my cancerous month flowing freely.

            At the barn, I am sad because of what gathers, but I normally measure time by counting the things that fade away. How many friends have left my life? How many would still be close if I had been more careful? I think of a wedding invitation to which I never responded. The envelope was full of glitter that lingered on my furniture like a guilty trace, long after the envelope had been discarded. How long had it been since I had seen the groom? How hard would it have been to graciously decline?

            Sorrow’s first substrate has always been regret. Hands unheld, words unspoken: These are the things that make me saddest. If we neglect what comes before, we do so in order to keep from crying constantly. In mourning Mick, I also mourn my time in Ithaca. I mourn gorge trails I will never walk again, with or without him. I cannot follow other paths with the map of those behind me still in my mind. Knowing that I must forget, I am adrift on sorrow’s sea, Odysseus in reverse, slowly carried away from the people and places I have loved most. This sadness seems as inconsolable as my past is irrecoverable.

            Irrecoverable? At Cecily’s wedding, I run into Miranda, someone I have not seen since we graduated from high school thirteen years ago. We walk together across the green lawns of Fort Worden. Soon enough, Jess falls into step with us. He left Ithaca before I did, but he is here now and he is laughing. Catherine catches up to us at last, and the three of them talk together, talk as if they had known each other longer than a day. I run ahead to greet Lily. When I turn, they are still there behind me, the sun at their backs. I see my teens, twenties, thirties, all together, all bathed in the same young light, synchronic.

settng sun.JPG

            In spite of myself, I always cry at weddings, but not because I am entirely unhappy. Cancer too is not without its consolations. Friends reach out to me, friends I have not spoken to in years. Improbably, I feel I have been given a second chance. The past saddens us not because we think we have gone wrong, but because we fear we have done wrong. Maybe I have. Maybe I can try again.

            When we imagine time we think of a line between then and now. We say, Time is a ray of light, eight minutes old, sent from a nearby star. I say, Time is a field, a field in which our friends walk, a field warmed by the setting sun. I am running ahead. There is time enough to fall back.

 

            -July 8th-12th, 2014, Washington, DC, Seattle, WA, and Port Townsend, WA

Sorrow: III. Evidence Missing

            I have never woken from surgery and not found myself crying. Each time, the feeling that something is missing washes over me. Isn’t it always, though? We invite white-coated mesmerists to lull us to sleep, and as we dream, their colleagues take something from us: A bit of blood or an ounce of flesh. Once it was my wisdom teeth, all four in a single day. Even before the anesthetics wore off, my mouth was an alien landscape, the strip mined ridge of Pennsylvania mountain range. Will I know when my thyroid is gone? Will I weep when it leaves me?

            Catherine says, It looks like a butterfly. And I add, An ugly one. Ill-made. This is the gland in question, two lobes like wings, unfluttering on the throat. My surgeon calls it an elegant organ, by which she means it is elegant in its imperfections. Mine may be more imperfect than most. Before she noticed the cancerous tissue, the pathologist examining my biopsy observed the leukocytes in the sample. These were the tell-tale traces of Hashimoto’s disease; white blood cells born with a grudge against the Lepidoptera in my neck. Their insecticidal campaign leaves the organ inflamed, a mass of irregular scar tissue. It is a wounded thing, my thyroid, but learning of its injuries makes me want to hold it closer.

            I will never hold it close again. The operation will begin on Wednesday at noon, but I will already be asleep by then, anticipating absence. Removing it could take as little as two hours, but mine – flanked by its fraternal nodules, pockmarked by autoimmune invasions – should take longer. When my surgeon finally extracts it, her assistant will carry it off, take it to other rooms where it will be studied by other eyes. It will linger in the hospital long after I am discharged, a yellow monarch pinned to a peg board.

            At twenty five, William S. Burroughs severed the top joint of his pinky finger with a pair of poultry shears. He would later explain that this was part of a “Van Gogh routine” intended to impress a boy who had spurned him. Before he could send it off, he rushed with the euphoria of the injured to see his therapist. This was Burroughs’ last voluntary stop of the evening. His horrified analyst had him immediately confined to Bellevue where he was treated for schizophrenia. Used to such slights, Burroughs was more troubled when he learned that the arresting officers had confiscated his separated joint. They refused to return it after his release. If it turned up somewhere, they told him, they would have to go looking for the rest of the body.

            In the succeeding decades, Burroughs’ writing would grow increasingly fragmentary. Critics often explain this development by pointing to his drug use. The anarchic qualities of his prose, they propose, merely reflects the dissipated state of his mind. I wonder, though, whether he sometimes thought of his finger as he wrote. He had lost a part of himself; how could he not go looking for it? In the shattered pages of Naked Lunch and Nova Express, he would seek to recreate the stolen joint. A new origin myth for the cut up style: It begins with a desire for something long since pared away. No revolutionary act, his style bespeaks the persistence of his sorrow.

            Do I want to keep my thyroid after they take it out of me? Of course not. Not really. And yet I want to see it, to caress it, to cradle it if I can. What are our excised organs if not external evidence that we exist? Think of my thyroid under the microscope. Here I am outside myself, not in miniature but in pieces. Will I ever stop dreaming of what I have lost? How many mornings will I wake crying?

            Sometimes in the woods, a butterfly will land on your hand or settle on your backpack. To touch it would be to traumatize its fragile frame. You can only admire it in those brief moments before it flutters away.

Sorrow: II. Mick

            The last time I spoke to Mick, he asked me what it was like to take insulin. He had just been diagnosed with pancreatic cancer, a disease as fast and deadly as my own is languid and livable. His doctors discovered it in midsummer a year ago, just after I had left Ithaca. By the time I made it back in late August, his voice had grown hoarse and his face was lean, leaner than I remembered.

            It was winter when he called for advice. I was standing at a stove, worrying over more pots and pans than the four burners could accommodate. An experimental treatment, he told me. A slim chance. It might save his life; it would certainly destroy his pancreas. He wanted to prepare himself for life without it. Was it difficult to count carbs? Would the needles hurt? I thought about how little fat was left on his frame, how much more it hurts to shoot into muscle. Something was smoking on the stove. Could I call back later? No hesitation. Sure thing. Time enough for talk.

            When our dogs were still young, they would sometimes play together, rushing from Mick’s unfenced yard to mine and back again. Presto, the more agile of the two, would sometimes go low and slip between Bags’ legs, only to stand unexpectedly, flipping him onto his back. At this, Mick would always grumble, and soon enough he would call Bags home. Years passed and the dogs grew calmer. Bags would stroll over at night, standing quietly atop the hill at the back of my lawn like a vigilant wolf as Presto dozed lazily below. Sometimes Mick would follow, glass of wine in hand, to look askance at whatever I had on the grill. This was how we became friends: Introduced by dogs.

            In the mornings, we would walk through the woods, following worn trails down into the gorge as the dogs romped in fallen leaves. Mick had been a graduate student, though he was a carpenter by the time we met. He still read, more and more widely than I did, even when I was in the thick of my coursework. Out in the woods, he would sometimes chastise me for not having made it through this or that volume of Bataille or Marion. He would lend it to me, he said, but only if I returned it. Would he have noticed if I didn’t? The metal shop shelves that filled his house were heavy with everything I should have been reading, everything I wish I had read.

            When I first arrived in Ithaca there seemed to be a bookshop on every corner. Occasionally, the philosophy or literary criticism section of one would fill up suddenly, abruptly flush with every volume my friends and I had been coveting. We would descend like vultures, each of us taking our share and then fighting over the scraps. It was only much later that I realized we really were picking corpses clean. This is how we bury our dead in college towns: We spread their libraries on a hillside and let doctoral candidates carry them to the winds.

            Months after the novelist David Markson died of cancer, his books began to turn up on the shelves of the Strand, a store at which he had purchased many of them in the first place. Nothing special in and of itself – there were few rarities and even the signed volumes were cluttered with marginalia – this collection was mixed in with the rest of the inventory, announced only by Markson’s book plates. Few as they were devoted, Markson’s admirers gathered online to catalog their finds. Unready to mourn their master, they attempted to rebuild his textual body, one obsessively annotated work at a time.

            In February, Mick’s partner Sandy wrote to tell me that he had died unexpectedly. There were two memorial ceremonies, but I made it to neither of them. If I had, I might have told a story about the first time we walked through the gorge together. Did I ever tell you, Mick asked, that I was a foundling? He hadn’t. What exactly did that mean? He did not smile but his tone was wry. I was found – but not born – in a hospital. I might have told this story, might have struggled to say why. I might have told it, but I wasn’t there. I haven’t been back to Ithaca since.

            I never asked what happened to Mick’s library. What will I do if I come across his books when I return? I would want to gather them up. I would want to gather them up and take them home.

            Come, says Shakespeare’s Titus, take choice of all my library. And so beguile thy sorrows.

Sorrow: I. Angry

            Anger is not always truly transitive, but it should be.

            I did not fall ill so much as I learned that I was sick, my whole sense of self reconfigured by a three minute phone call. In the hours immediately after, I allowed myself little conscious emotion. At most, I was distantly aware of a desire for anger – not yet the feeling itself, only the longing to feel. Calling family members, I kept waiting for one of them to slip up, to say something stupid. More than anything, I wanted to be angry and my anger wanted an object. In the end, my loved ones disappointed me: They were unfailingly caring, unfailingly careful.

            When I was young, one of my friends would sometimes speak in awestruck tones of his father’s fury. He told me there were places in the plaster walls of his house marred by deep dents and gashes, the ugly signature of misdirected paternal power. Half-conscious of what I was hearing, I watched my friend for signs of more personal violence, but there were none, none that I could see. Did my friend’s father strike the walls to keep himself from harming the children?

            In college, angry at my own father, I once lashed out at a dorm room wall. It wasn’t so much a punch – I could hardly muster the force – as a lazy throw, an arm launched in a parabolic arc, a fist inexplicably trailing in advance. Though I managed to do little more than scrape my knuckles, there was a certain satisfaction in the act. In this quartered sting, my flailing frustration at least found a bodily orientation. My anger was directed at the wall now, one ugly feeling supplanted by another more manageable.

            I still sometimes worry about my friend, though he is grown now and has a family of his own. Anger doesn’t go away just because we redirect it. No, it lingers miasmically, lulls us into a thrashing sleep. Spinoza claims that anger is a kind of sadness, a kind of sadness caused by something beyond oneself. When we are sad, he says, we feel as if we are restrained, incapable of acting on our own behalf. In anger, we attempt to regain our lost capacity by acting out against that which seems to hold us down. When our fists flash out, when our words cut, we briefly escape sorrow by the very fact of our aggression. Centuries before Freud, Spinoza proposed that we recover from sadness by understanding the forces that render us inactive. Anger, he holds, offers only the illusion of relief, proposing a single cause where a more meditative mind would find many.

            I am angry now, angry at my cancer. I tell Kitty that this is strange for me, that I am rarely angry, and she seems puzzled. You are often angry, she says. She is not wrong. Sometimes I am tempestuous: Storms brew and ships sink. What clears the sky? I study how the winds blow. I parlay with the Aeolian kings and we exchange gifts of friendship. Against my anger, I seek to understand the causes of my sorrow. Cancer offers no such recourse. I do not know why I have cancer, so I cannot sail on any more than I can still this unquiet air.

            Was I exposed to radiation when I was young? Did something seep out of the bottling plant downtown? I do not know. I cannot know. Absent some clearer cause, my anger falls only on the body in which cancer takes root, the body that cancer reveals, my body. Anger should propel me into action, but it only makes me stiller, makes me stiller because it makes me sadder. Both subject and object of anger, I dwell on the very things that angered me, the very things that are me. As I survey my body with narrowing eyes, it gives me more reason to rage. My anger circulates endlessly, divides endlessly. Directionless, it claws downward, plumbing the limits of my limbs, coiling around my organs. My anger metastasizes. My anger is a kind of cancer.

            If I could, I would pull my thyroid from my throat today. But I do not. I cannot. Instead, I wait, watching sorrowful clouds gather overhead.

Lonely: IV. Strangeness Made Sense

            In Belfast, the poet Philip Larkin claims to have found a comfort that eluded him in his native England. It was, he suggests in “The Importance of Elsewhere,” the very otherness of the place that set him at ease, the otherness of the place or his otherness to it.

 

            Lonely in Ireland, since it was not home,

            Strangeness made sense. The salt rebuff of speech

            Insisting so on difference, made me welcome:

            Once that was recognized, we were in touch

 

The lyricism of these lines is more thematic than formal. Holding the speaker at a distance, the ends of the first two all but rhyme in their refusal of proximity. “Not home” and “salt rebuff” cast sideways glances at Larkin, stamping his passport without granting him residence. This dynamic is not undone in the second half of the stanza, but advanced to the point of inversion. “Made me welcome” and “we were in touch” mirror their antecedents, and in mirroring reverse them. It is precisely because he is a stranger in a strange land that he can make sense of strangeness. Loneliness, Larkin suggests, prescribes its own antidote.

            I was not lonely during my own trip to Ireland, but I saw myself in the loneliness of its landscapes, most of all on Inis Mór. A little over seven miles long and two miles wide at its broadest, Inis Mór sits just off the Galway coast. Geologically, its terrain is an extension of The Burren, a desolate and rocky region that covers parts of Western Ireland. Tourists swarm the island during the day, crowding its narrow roads with rented bicycles. At night, after the visitors return to the mainland, the emptiness of the palce asserts itself. You are reminded that small as it is its population is smaller still.

            Its population is small, yes, but not new. Climb the slow and steep hills at the center of the island and you’ll find yourself on a strip of rolling cliffs that stand three hundred feet above the ocean. With my legs dangling over the lip of one in a gesture of forced ease, I could feel my shoulders tightening. Perched over the Atlantic, I was acutely aware of how small I am, how fragile. You know the feeling: We do not want to jump when we stand on the edge of the world, but we worry that we might. Confronted with something infinitely larger than ourselves, we fear we are no longer our own masters. In the way waves collide with the sheer rock, in the pillars of spume that shoot up, we see a causal system that exceed us in every way. How can I control my own limbs when the world moves so powerfully around me?

Ireland Etc 252.JPG

            Was it this sentiment that led the first residents of Inis Mór to begin Dún Aonghasa some three thousand years ago? Stone Age in the most literal sense, Dún Aonghasa is a fort built almost exclusively of large black rocks piled atop one another to form massive concentric circles. In places, the walls are supported by buttresses of more recent vintage. Elsewhere, pale concrete blocks fill gaps in the rampart. Nevertheless, Dún Aonghasa remains improbably primeval, a suppurating wound in time that leaks pure history.

Ireland Etc 255.JPG

            This much-studied monument guards its secrets as assiduously as it once did its ancient architects. Why did they place it atop this bluff? Why do its outer walls gape open where they meet the edge? Facing away from Ireland and the continent beyond, Dún Aonghasa looks out on endless ocean, a watchtower against unimaginable threats from nowhere. Standing inside, I imagined its builders raised these walls not to keep others out but to hold themselves in. Standing inside, they faced the enormity of the ocean and steeled themselves against it.

            Dún Aonghasa is a lonely place, lonely in the way we always are when we attempt to master our world. As soon as we seek to buffer ourselves against forces we cannot control, we shut out everything beyond our walls, and thereby stand alone. We lose the possibility of contact and love by the very gesture that allows us to restrain risk. Accordingly, one last reason cancer makes us lonely: A seed sprouts in us, a seed we never planted. Angry, we strive to ensure nothing will grow again, so we salt the earth. We should not fault ourselves for this inward turning aggression. Finding no responsibility within for the disease that wrongs us, we feel cancer has stolen our power. In struggling for control, we merely attempt to reclaim it. And in struggling for control we make ourselves lonely.

            But loneliness, we know, prescribes its own antidote. Ireland appealed to Larkin in part because he needed make no excuses for his lack of self-control there. In 1955, he left Bristol for good to take a job in Hull, a move that might have prompted the lament that closes “The Importance of Elsewhere”:

 

            These are my customs and establishments

            It would be more serious to refuse.

            Here no elsewhere underwrites my existence.

 

Home again in England, Larkin finds himself castigated for behaviors that were dismissed in Ireland. On one reading, what he ultimately celebrates in the poem is not elsewhere as such, but the pleasures of irresponsibility. Ireland allows him to delight in not being held accountable for his every action. In the libraries and living rooms of Bristol he languished in his lack of control – over himself as over his world.

            Was Larkin responsible for the esophageal cancer that took his life in 1985? If he wasn’t, was he any less a poet? Cancer makes us lonely because with it we are no longer at home in ourselves. In our loneliness, the world becomes strange, but in strangeness there may be a certain sense. I think of a shattered stone wall that I saw on the coast of Inis Mór. Battered by the sea, it can neither contain nor restrain. And yet it stands.

Ireland Etc 306.JPG

 

 

            (With gratitude to Nigel Alderman)

 

            -June 28th-July 7th, 2014, Washington, DC and Ilion, NY

 

Reading Spinoza in December

To see the crystalline composition of ice

You must step on it. Watch the way it fractures

Beneath your boot. These jagged spokes

Speak the radial secrets of its nature.

Ice strives to shatter. It desires only

The lugged force of a foot descending.

 

In this there is nothing of the occult.

What is material remains so. What is

Solid declines to sublime. Broken ice

Is still ice. Bringing this to light will not

Invite the warmth of winter sun.

 

Studying the fragments, you might

Imagine you can intuit the whole

From which they come. This edge

Fits into that wedge: This piece and that one

Obviously rhyme. Still, something is missing,

The very effort of understanding

Having reduced hard shapes to powder.

Diabetesversary

            Though cancer comes as a shock, illness is no surprise now.

            The summer after my first year in graduate school we drank caipirinhas. Cut limes into quarters, into eighths. Place them in the bottom of a cup, blanket them with sugar, muddle the mixture to form a thick paste. This was the ritual. The cachaça – a foul-tasting Brazilian spirit – that we would pour in next came almost as an afterthought. Sometimes when my glass was empty, I would eat the sweetened limes, peeling smashed flesh from the rind with my teeth.

            When the acid reflux started, I at first imagined all the citrus was somehow to blame. There were plenty of things wrong with my body that summer: I had lost twenty pounds in two months, my muscles locked up whenever I went swimming, I felt sick all the time. My mother asked me to take down a picture I had posted to Facebook, horrified by how gaunt I was. In retrospect, I should have guessed that something was amiss. Nevertheless, it was the unpleasant sensation that crept up my throat and filled my chest that I worried over most. Everything else, I assumed, was surely the product of overwork, the exhaustion of two semesters collapsing on me all at once.

            The most obvious symptom appeared to be nothing of the kind: I craved sugar all the time, craved it with a loopy enthusiasm. Sometime in late June, I marched into the living room where Celeste was working, stamped my feet, and proclaimed, “Baby Martians need cupcakes!” On the first day of July, Jess stopped by while I was languishing in bed, queasy with an unfevered flu. When he asked if I needed anything, I sent him out for milkshakes. He has never forgiven himself for complying.  

            All this, and yet when I made my way to the student health center it was the reflux and the reflux alone that I mentioned. My other issues came up as a matter of course, idle facts elicited by the standard medical inquiry. I watched my doctor adding them up in his head. When I asked him what might be wrong, he frowned, bit his lower lip, and hesitantly proposed leukemia. Talk about all roads!

            Here’s what was wrong with me: A minor infection that had torn through me in January, one easily treated with antibiotics, had flipped a long dormant genetic switch. Instead of fighting the infection, my immune system had begun to release leukocytes coded to attack the insulin-producing eyelet cells of the pancreas. As this autoimmune siege proceeded, my body grew increasingly incapable of processing carbohydrates. Stagnant, they degraded into acid, perilously lowering the pH of my blood and sending me spiraling into a potentially fatal condition called ketoacidosis. Perversely, my inability to process glucose led me to long for sweet things, exponentially intensifying the state of emergency. As the normally self-regulating feedback loops of the endocrine system broke down, my body literally consumed itself from the inside.

            This, at any rate, was the story that my blood work would tell the day after my clinic visit. It would be months, however, before I could tell it from beginning to end, and, even now, parts of it remain largely conjectural. When my doctor called, I knew none of this. I heard only four strange syllables, each of them a needle pricking the skin: Die-a-beet-ees. Diabetes? Celeste was baffled when I told her what I had. She shook her head, looked at me sideways. “No you don’t.”

            I did, though I found it equally implausible. At my doctor’s insistence, I would take a cab to the hospital that night, this night, seven years ago. The next day, friends called to check in. When Celeste handed me the phone, I would apologize to them for ruining the holiday. I felt as if I had let the burger patties spoil in the sun, left the fireworks out in the rain.

            In the hospital, I learned to pull synthetic insulin from a vial. I steeled myself to press needles into the adipose tissue of my stomach. I studied carb counting and the signs of low blood sugar episodes. I was no expert by the time I was released three days later, washed clean of acid, still weak. I was no expert, but I would become one. I would become one and I would survive, survive largely without consequences through seven years of endless self-care.

            Seven years. Seven years today. Diabetesversary. Insulin Dependence Day. This is my holiday, so I will allow myself one punning cliché: There is no sugarcoating diabetes. Like all chronic illnesses, it is a daily burden, one that never fades into the background. And yet we carry on. We do not live with our diseases but in spite of them.

            Seven years today. Have a cupcake with me. The baby Martians are hungry.

Lonely: III. On Ice

            In late 1974, a young Werner Herzog learned that the filmmaker and critic Lotte Eisner had fallen critically ill. Fearing that German cinema could not do without her, Herzog vowed to cross the five hundred miles between Munich and Paris on foot. This solitary trip took him twenty-two days, days of freezing weather on unforgiving roads. Why set out at all? In his diary of the journey, published in English as Of Walking in Ice, Herzog claims he believed his labors would somehow save Eisner’s life. Perhaps he also made his way through the wilderness alone to make her sickness tangible.

            Much has been made of Herzog’s conviction that nature is brutal and unforgiving. In an elegant essay on Of Walking, the cinematographer John Bailey proposes that the book offers just such an interpretative guide to Herzog’s work. “To be as reductive as possible,” Bailey writes, the book shows, “Nature is not our friend.” No, nature is not our friend, but its unamiability is not always immediately evident. If it were, would Herzog have spent so much of his career insisting on it? Far from merely depicting the violence of the inhuman world, Herzog’s work aggressively calls attention to it. His career might be understood as a lengthy exegesis of nature’s crimes, an attempt to unveil a truth that would otherwise go hidden.

            Almost without exception, Herzog’s works can be read as turf wars with the unreal. In his documentaries, his own presence sometimes seems to falsify the stories he tells. Instead of demonstrating the inaccessibility of truth, Herzog’s subjective brinkmanship demands a more coherent reality principle. His fictionalizing grand gestures highlight the way reality slips away from us every day.  As he performs them, he calls on his viewers to halt its flight.

            Consider the material counterpoint to Herzog’s narrative games, his equally profound interest in substantiality. Five years after the events of Walking, Herzog would haul a steamboat over a mountain for Fitzcarraldo. More than mock-heroic stunts, such feats dramatize a longing for material stability. On the one hand, Herzog reminds us that certainty always escapes us, just as Fitzcarraldo’s boat repeatedly slides down the slope. On the other, he constantly seeks to reassert the mere possibility of definite knowledge through acts of corporeal legerdemain.

            Herzog’s vaunted discomfort with the natural should be understood, then, as an attempt to make nature more real. No mere myths of original violence, his works struggle to brush away the shimmering skein of myth itself, to pull back the veil separating us from the fact of the world. The journey he describes in Walking does much more than depict the hostility of the wilds through which its narrator passes. Here it is his destination and the ailing friend who waits there that matter most. Herzog sets out into an unforgiving elsewhere in an attempt to substantiate that which is almost always terrifyingly illusory: Illness itself.

            I have suggested that cancer makes us lonely because it is so wholly our own. Perhaps it is also because sickness never quite feels real. Even as my disease returns my body to me, I find it hard to believe that I am unwell. Cancer is incredible – incredible in the strictest possible sense! – because it fills my whole horizon when I think of it, occludes the world. With cancer, I am estranged not from myself, but from everything else that falls under the rubric of the real. My own life becomes a fabrication, a work of fiction, while those around me live documentarily.

            In a letter to another recently diagnosed friend, I find myself writing about Wittgenstein again. He posits in his Investigations that philosophy too often finds its problems in language rather than the world. Pursuing invented linguistic concerns, we lose our points of reference, our everyday anchors: “We have got on to slippery ice where there is no friction… we are unable to walk. We want to walk: so we need friction. Back to the rough ground!” Like the language of philosophy, illness blots out the sun. A freezing rain falls and the ground grows slick. Soon, we are skating alone, skating without pleasure. We can only proceed if we acknowledge the difficulty of our situation, thereby making things more difficult still.

            I write to my friend: Maybe it is the ways in which the world is difficult, really difficult, that make it real for us. Cancer is difficult, so we work on it. We work on it in order to make the walls stand, the chair firm, the floor hard. Cancer makes the world unreal, so we work on cancer to make things real again. Making things real means making a world which means making them together. My friend writes to me and I write back. Our cancers are still our own, but maybe they are a little more substantial. Maybe we are a little less alone.

            From Munich to Paris, Herzog walked on ice until he walked in it. See it crumbling beneath his feet from the very difficulty of the task. Step on ice hard enough and sometimes the ground reveals itself. Eisner was still alive when he arrived at her side in mid-December. She would live almost a decade longer.

Lonely: II. Together

            The loneliness of cancer derives most of all from its particularity. Speaking the respectful language of support groups, survivors repeat the truism, “Everyone’s cancer is different.” At this juncture two roads seem to diverge: Everyone’s cancer is different; therefore each of us is alone. Everyone’s cancer is different; therefore we are conjoined in and through our isolation. We walk alone with the same steps that allow us to walk together.

            On Saturday, we drive past Baltimore, leave the main road, head into the woods. Amanda guides us along a muddy trail to a small waterfall that tumbles down into a calm pool. We lay out beach towels on an overgrown slope, eat gazpacho out of coffee mugs. Everyone has brought a package of tiny carrots and a container of hummus. Sated, we venture into the frigid water one at a time. Someone makes a joke about folk wisdom, but no one waits a full half hour.

            Then as now, it occurs to me that the normalcy of this occasion should feel strange. In an examination room eight days earlier, my surgeon tells me that I have likely been living with cancer for a year or two, maybe more. It was discovered, as thyroid cancer almost always is, largely by chance, not because it asserted itself. Slow to metastasize, it presented little risk as those unknowing months piled up. I imagine it puttering about inside me like a new college grad, unsure what it wants to do with its life. Should I get a masters? Is it too late to go into consulting? At night I occasionally worry that the diagnosis has somehow made my cancer more aggressive. Rationally, I know that it is as languorous as ever. On Saturday, I float in chilly water and it floats with me. It is unhurried, so I allow myself to be so too.

            Time passes. Someone points, showing us that Dave, already made small by the space between, is slogging upstream. Impulsively, I swim after him, clamber over the waterfall, stand in the shallow stream above. Following at a distance, I leap from rock to rock, improbably committed at first to keeping my feet dry, despite my soaking shorts. Up ahead, I see Dave sit down for a moment and then stand again before continuing on his way. I am puzzled by this action until I reach the same spot a few minutes later. Suddenly unsure of themselves, my feet slip out from under me into newly deep water and I am sitting too. Like Dave, I begin to move more carefully, eyes on the ground, sometimes crawling.

            Dave and his wife Brittany were the first friends that I spoke to after I heard the news. I told them in part because they were there and in part because I knew they would respond with calm. Following Dave upstream, I am reminded of why speaking to him felt right. His path is not my own, but I take something from the determined way he walks it. Sometimes he cuts along the bank while I struggle against the current. Sometimes I trace his damp footprints over dry rocks. I neither hurry to join him nor call out for him to hold back. If he knows I am behind him, he shows no sign.

            We have traveled maybe half a mile before I realize that I too am followed. Turning to review the route already taken, I see Patrick a hundred yards back, see him crouched low to maintain his balance. Somewhere behind him, Ron is also coming along, still in the spot where the rocks jut out of the water with the regularity of paving stones on an old Roman road. The four of us trudge along like this for a while, a caravan of solitary travelers. Here the stream is wide and slow, here it is narrow and fast. Fallen green ash trees reach from bank to bank, meeting to form organic arches. Small fish and tadpoles dart about in the shallows. At times we trip and fall. At times we swim, hands ahead of us to guard against submerged rocks. None of us has brought a camera. We do not need one. We will wear our cuts and bruises like memories.

            Hours later at the waterfall, I mention that I swallowed a mouthful or two of the stream when I faceplanted half way back, just before I came across Catherine who had ventured out after us. Dave jokes that I have dysentery, suggests that I’ll have to make friends with the new residents of my stomach. I laugh and I do not think of cancer.

            This is how I envision our loneliness. We reach out to and toward others, others we cannot touch. We do without contact, but not without their company. We are making our way upstream, making our way alone, making our way together.

 

Lonely: I. Arche-texture

            The first hour is the loneliest, and it gives form to all those that follow.

            Looking through my phone, I am surprised to discover that the initial call with my endocrinologist lasted only three minutes. I say surprised because our conversation seems longer and fuller when I call it back to mind. Though she is precise and thorough, something in her tone suggests sorrow. This is a call she has made many times.

            It is late afternoon, still sunny, a Tuesday. I am at home, perched on the living room couch, books and papers piled all around, secure in a fortress of letters. That brief exchange is a hinge: One version of me remains on the left side, forever staring at the computer, forever willing myself to write. On the other is a creature made more vital by the knowledge that it is sick. New born, this second self comes into the world bereft. For an hour, it has no friends, no family. Do not worry: It will find them.

            Many of those who write to me explain that they remember the moments after their own cancer diagnoses with uncommon clarity. One friend tells me that even after a decade she can still feel the plastic of the black hospital telephone she used to call her parents. She says that we become survivors as soon as we hear the news. Are we survivors because we are, if only for a moment, alone? We find ourselves in a frozen world and we are shivering. Accompanied only by our diseases, we find that we must make our own way. We will teach ourselves to kindle fires, learn to forage for food. When we are strong enough, we will follow the river until we make our way back to the camp where the others wait. They will cover us in blankets or blanket us with their bodies and we will be warm again. We will be warm again, but we will carry the wilderness with us all the same.

            On Tuesday, I rise from the couch, hesitantly at first. Standing on weak legs, I fumble with my phone, determined fingers tapping simulated keys. Catherine texts that she is in a meeting, writes that she will call as soon as she gets free. My mother is not answering, Karyle is not answering, my father is at work. Not wanting to upset before I have the chance to assure, I leave no messages, give nothing away. I know that I will reach them soon enough, and soon enough I do. But for that first hour I, newborn, am an unaccompanied minor – fumbling for language, gasping for air.

            In these solitary minutes, I sense the shape of days ahead. Call the loneliness of that first hour the arche-texture of cancer. Arche-texture? The tangible feeling of an origin, an origin that gives shape to everything after. Our first experience of cancer is ours alone, and it forever characterizes the specificity of our own cancer. Some version of us will always stand apart, at home in the house that cancer built. Loneliness is the insulation in the walls, muffling the clatter from without. Loneliness is the lock on the door. Who else could turn the key?

            Let me be clear: Others provide comfort and solace. To be persistently lonely is not always to really be alone. There is, however, a place where they cannot join us, a place they could have never kept us from entering. Ask me how I am feeling and I might tell you that I am a little lonely. But I’ll tell you this too: It’s not because you’re not beside me.

            On Tuesday, Catherine rushes to my house as soon as she hears the news. I still haven’t left the living room by the time she arrives. The couch, piled high with my books and papers, is an island now and she joins me there. It is a small place. Huddling together, we make ourselves smaller still. 

Sympathy

            When we worry over our symptoms, we are, in the strictest sense, worrying about ourselves. The symptom is what is happening to me, what is happening in my body. Even when they restore my agency, even when they unveil the tightly coiled spring of my potentiality, my symptoms are always my symptoms. Inevitably, though, disease is a social thing. What we feel is our own, but others hurt too.

            Tell people that you are sick and they will ask you how you are feeling. They will ask you and you will tell them, each time with the same words in the same sequence. Your mind will wander as you recite the formula, these words that have already become a kind of ritual incantation. Drifting off, you will think about how strange the question is, about the way it suggests an improbable inquiry into sensation as such. How are you feeling? What does it mean to feel? What allows us to have feelings at all?

            Finishing your routine, you will return to the room. You will remember that you have really been asked, “What are you feeling?” Rate your pain on a one to ten scale. We both understand numbers. Maybe they will help us understand each other. You have been asked this question by someone desperate to grasp something that will always slip out of their hands. You have been asked this question by someone who is sympathetic, but who cannot understand what sympathy demands.

            The fault is not their own: Where the etymology of “symptom” suggests passivity, the origins of “sympathy” propose an impossible activity. From words meaning “with” and “feeling,” sympathy promises a radical correspondence with the other. When those we love are sick, we pursue this proposal to its illusory end: We want to feel as our unfortunate other does, feel what they feel. That we cannot do so is the tragedy of the sympathetic spirit. I feel, but I will never truly feel with you, much as I might try.

            Sympathy thus begets a kind of paralysis. Acutely aware of our inadequacy, we render ourselves incapable of emotional action, frozen in our attempts to reach across the void. Let us be kinder to ourselves, to our others. In the end, sympathy does not, cannot, offer complete understanding of the other’s pain. Sympathy dissolves instead into the bare fact of connection with others, the desire for a bond that we know will always be incomplete. The sympathetic want most of all to walk beside the sick. When someone asks how you are feeling, they are really asking you to tell them what they should feel. They want to know what they should do and how they can do it with you.

            What should you feel? I cannot tell you. I do not know. But I am so, so thankful that you asked.

            Walk with me.

Symptomatology: IV. Strange Agency

            An old friend writes from Spain to remind me that bodily knowledge is always knowledge of beauty. Do we think cancer makes us uglier? Is this the power that it holds over us? Is this why it shames us?

            When we look at an object and wonder aloud whether or not it “is art” we really mean to say, “Is it beautiful?” Criticism of the kind that I both practice and teach typically suspends these questions, declining matters of beauty and value. I seek, instead, to interrogate what my objects do, how they act when I interact with them. In the classroom, I encourage students who ask me about value by asking about “art” to rethink their premises. Art, I propose, is nothing more and nothing less than what we set in a frame.

            This smallest of definitions is not, I hope, as glib as it first seems. To frame an object is to remove it from the everyday. The frame, as Jacques Derrida posits, is like a DMZ, simultaneously belonging and not belonging to both the work and the wall on which it hangs. Yet where it partakes of both domains, it allows no exchange between them. Frames, then, are the markers of difference as such. They exist to show us that works of art do not belong to our world, our life. Art’s ways, frames tell us, are not our own.

            Cancer too is something set aside. While the cells that make it up are our own, their relentless multiplication transforms them something other, something alien. Its fatality is its frame, a looming menace that promises to foreclose the growth of both invader and host. While it would be dangerous to aestheticize cancer, it may be the case that cancer shares certain properties with aesthetic objects. If so, it is certainly not in Kantian terms, where that which we deem beautiful can have no bearing on our lives. Cancer is other, monstrously other, but it affects us all the same.

            No, cancer is not disinterested; it approaches aesthetics only through its power to upset. Viktor Shlovsky, oddly anticipating Wittgenstein, argued in 1917 that art serves primarily to jolt us out of our ordinary way of doing things. Imagine walking through a dark room, one you pass cross every night. You know your path so well that you never turn on the lights. Tonight, however, someone has moved the ottoman and you stumble over it, banging your toe and bruising your knee. The pain of unexpected discovery shocks us, but it also forces us to rethink the way we move through the world. This, Shlovsky holds, is what art does: By estranging us from everyday experience it contests the habitual, returning actions that have become unconscious to the thinking mind.

            The body comes to know itself in pain, and in pain it begins to learn what it can do. With this knowledge comes the awareness – however subtle – that the body is made up of bodies, bodies that act on and with one another. In the absence of my thyroid, my countless small bodies will rearrange themselves around the void. They will find new paths of their own, new ways of mourning in the face of a new loss.

            I, for my own part, have already begun to do so. Cancer has upset me, yes, but in upsetting it gives me back my own small power – not power over but power to. I write these words longhand in a teal notebook I had earmarked for poetry, a notebook long left empty. My own habits once inclined me toward stillness and silence. How strange that seems now.

            The final symptom of cancer is not death, but action, conscious action.

            -Washington, DC, June 23rd-26th, 2014

 Enjoy your symptom!

Enjoy your symptom!

Symptomatology: III. What Bodies Know

            In a photograph taken three days after my diagnosis I am standing in the sun. Catherine is beside me, smiling, radiating calm. We train our eyes, as we so often do, on the same object, something off camera that we gaze at in different ways. In my right hand, slung low, I am holding a can of the beer that Jess and I have brought to summer cookouts for almost a decade. Studying this composition, you might not suppose that anything was amiss were it not for the position of my left hand. It hovers mere centimeters from my neck, thumb and forefinger almost, but not quite, pinching my trachea. In another context, I might be clutching my pearls. Instead, I seem to be caressing the space where my thyroid soon will not be.

 Photograph by Laura Toscano

Photograph by Laura Toscano

            The action is unconscious, of course, but I can only read it as symptomatic, indicative of some deeper bodily knowledge. Some deeper bodily knowledge? It would be more accurate to say some knowledge of the body itself, knowledge within the body and of the body. Ask me a month ago to point to my thyroid and I would have hesitated before gesturing broadly toward my neck, a stoned Vanna White revealing a letter. Earlier illness had taught me that it was there, but my grasp of it was purely theoretical. And yet there I am in the photograph, all but clinging to this tiny gland, my body reaching out to a newly estranged fragment of itself.

            Ludwig Wittgenstein suggests in his Philosophical Investigations that rules only become available to us as rules when we don’t know how to follow them. Under ordinary circumstances, he claims, we go about our everyday business without questioning the guidelines that we follow as we do so. When we encounter a moment of uncertainty – in language as in life – we interpret, interrogating the possible expressions of a rule. Crises of meaning thereby invite us to examine phenomena that we would never glimpse under other circumstances.

            Wittgenstein himself would die of prostate cancer before he had a chance to publish his Investigations. To the best of my knowledge there are no photographs of him touching the troubled organ, and if there are they will rightly remain in private hands. I wonder, though, whether he ever really considered its presence before it began to pain him. While Hashimoto’s disease taught me what a thyroid does, my own cancer has shown me that my thyroid is. This is my paradox: Only when I prepare to remove a part of myself do I really grasp its presence. What’s more, it is precisely the threatening expansion of the gland into other tissue that speaks to me of its original shape.

            Illness isolates that which it attacks, even as it shatters the systems from which its targets derive. There is an opportunity in this excruciating opening: Wholes are hard to see, especially when they constitute our entire horizon. Fragments, by contrast, make our bodies available to us by showing us what has been or will be lost. Cancer renders our bodies as bodies, shows us the whole by tearing us to pieces. My body itself, my body in ruins, is the felt symptom of my knowledge of disease.

            Catherine and I are standing in the sun. We both know that I have cancer. My body knows more, knows itself, as if for the first time.

Symptomatology: II. Giving Names

            All symptoms threaten us with cancer because cancer is an abstraction. Knowing that our bodies have something to say but unsure how to understand them, we take their every utterance to mean the same thing. Ventriloquial cancer, the disease which is not one, is the one disease that can speak through anything, and it whispers to us in all tongues.

            How much stranger things become when this polymorphous shadow takes definite shape. Cancer is one thing: pure potentiality, pure menace. But where cancer as such names the bare fact of an antagonistic power, cancer with a name promises some power to the patient. Why do gods hide their true names? Because they think naming makes them small. Because they know that what is small is actionable.

            Still, names sometimes sprout thorns when we try to handle them. Just as we are warned against indiscriminately researching our symptoms, so too should we avoid aggressively investigating our diseases. Uncertainty produces anxiety because when we know too little we tell ourselves too many stories. But knowledge begets knowledge, and knowing too much can paralyze us. Read widely about a loved one’s ailments or your own and you will wind up frozen, suspended between penetrating dread and false hopes.

            My own endocrinologist suggested a single site, one that offered a repository of information gathered by thyroid cancer survivors. Their introductory handbook is thorough and measured. It lays out survival rates (high) and treatment options (primarily surgical) with precision and care. I should have been reassured. Why, then, did reading the section on my disease’s symptoms leave me publicly sobbing on the metro?

            Thyroid cancer rarely reveals itself in its early stages, causing neither pain nor impairment. Indeed, it can sometimes go undiagnosed for years, cells quietly multiplying at a glacial pace. It is the nodules in which it takes root that are typically discovered first. Sometimes, only sometimes, their small swellings produce the kind of symptoms that might be misattributed to the common cold. I was neither hoarse nor short of breath, but that rounded pressure in my throat, the marble just above my breast bone, was suddenly hard to ignore.

            Similarly unavoidable, was the difficulty swallowing I noticed at my next meal. The muscular contractions of peristalsis, normally as routine as exhaling stale air, began to feel like a conscious action. Food coated the roof of my mouth, pushed back against my tongue, explored the walls of my esophagus. I told myself the feeling was psychosomatic, but the knowledge provided no comfort. Whether my disease was asserting itself or I was asserting the reality of my disease, the fact was that it was there.

            So why did I break into tears? Perhaps because I already sensed that the very idea of a symptom can give shape to unwanted sensation. My doctors had given name to my cancer. In its own turn, my cancer had given name to things I might never have otherwise noticed. In the first days after my diagnosis, cancer had been a dream and my actions in response to it those of a sleepwalker. Symptoms, the mere names of symptoms, shocked me awake.

            Here I am, sitting bolt upright in an unmade bed.

Symptomatology: I. All Roads

            Nothing makes us feel sicker than Googling our symptoms when we feel sick. The results, we learn, are always the same: Scratchy throat? Cancer. Blurry vision? Cancer. Frequent urination? Cancer. The network of diseases that share this name encompasses so many ailments that almost anything can indicate it. In medical discourse, symptomatology encompasses the sum of all an illness’ characteristics. To speak of the symptomatology of cancer as such may be to speak of the mere fact of bodily failure.

            To no small extent, the fear that cancer generates may be a consequence of its semiotic openness. When anything can point to cancer, cancer can be anywhere. Every twitch and every twinge signifies the possibility that our bodies are no longer our own, that they have been made otherwise by something moving within them. In its abstraction, cancer becomes the monomyth of all symptoms, the story before and behind every story.

            The word “symptom” itself derives from a Greek root that means occurrence or happening. Etymologically, this suggests that our relation to our symptoms is passive, that they befall us. We are discovered by our symptoms, not the other way around. Our symptoms surprise us as we walk out the door, trip us as we walk along familiar paths. The symptom is kin to the anomaly, disrupting the way we ordinarily do things and thereby challenging our ability to do anything at all.

            In practice, though, symptoms only become symptoms when we turn them into events, when we imbue them with the potential to mean. I feel a slight pressure in my throat. Would I have noticed it a month ago? Would it have meant as much before last Tuesday? If all symptoms name cancer, it may be because, for us, cancer names the very possibility of a symptom. Cancer is the absolute horizon of biomedical meaning. Forget Google! When we set out to interpret the signals sent by our bodies, it may always already be cancer that tells us they signify something more.