A Diagnosis

The future​ flashed before my eyes in all its pre-ordained banality. Embarrassment, at first, to the exclusion of all other feelings. But embarrassment curled at the edges with a weariness, the sort that comes over you when you are set on a track by something outside your control, and which, although it is not your experience, is so known in all its cultural forms that you could unscrew the cap of the pen in your hand and jot down in the notebook on your lap every single thing that will happen and everything that will be felt for the foreseeable future. Including the surprises.

I got a joke in.

‘So – we’d better get cooking the meth,’ I said to the Poet, sitting to one side and slightly behind me. The Poet with an effort got his face to work and responded properly. ‘This time we quit while the going’s good.’ The doctor and nurse were blank. When we got home the Poet said he supposed they didn’t watch much US TV drama. It was only later that I thought that maybe, ever since Breaking Bad’s first broadcast, oncologists and their nurses all over the Western world have been subjected to the meth-cooking joke each time they have applied their latest, assiduously rehearsed, non-brutal techniques for telling a patient as gently but honestly as possible, having first sized up their inner resilience with a few apparently innocent questions (‘Tell me what you have been expecting from this appointment’), that they have inoperable cancer. Perhaps they failed to laugh at my – doubtless evasive – bid to lighten the mood, not because they didn’t get the reference, but because they had said to each other too often after such an appointment: ‘If I hear one more patient say they should start cooking meth, I’m going to wrestle them to the ground and bellow death into their faces – “Pay attention, I’m fucking telling you something important!”’ I was mortified at the thought that before I’d properly started out on the cancer road, I’d committed my first platitude. I was already a predictable cancer patient.

Then again, what if I had taken the other option, and sat in dignified silence for a moment collecting myself, which I’m sure is how one would describe the short hiatus, and then asked serious, intelligent questions about the nature of the treatment the Onc Doc was suggesting, not to ‘cure’ me (he had slipped that in right at the start for me to run with or blank out, as I chose), but which had a 20 to 30 per cent chance of producing a remission for an unguessable period? After listening as carefully as my muddled head could manage to his answer (three cycles of chemotherapy, a scan, a course of radiotherapy, taking us up to Christmas, almost, then we would see), I would then be obliged to ask the next, inevitable ‘how long’ question, hedged about with all the get-out clauses for Onc Doc, who after all wasn’t to blame for my cancer.

‘Of course, I understand it would be unreasonable of me to expect you to know, with any certainty, when I’m likely to die if I have the treatment. I’m sure it’s different for everyone, and only based on statistics, but could you perhaps give me a general idea: years … months … weeks?’

The print size in my mind decreased with time’s incremental decline, and as I arrived at the last word – weeks – it suddenly struck me, with all the force of the fullest sense of the word ‘struck’, that this could actually be his answer and not just the logical next time period in my sentence. Every cell in my body, except those responsible for maintaining a reasonable, calm exterior, was now lindy-hopping at that possibility, the only one that hadn’t occurred to me until that moment. Weeks. Still, the question itself was there waiting in line for me in the ready-made scripts file, for this unique to me but culturally familiar diagnostic moment, just after the Contemporary International Smart Cancer Joke.

Not that I’ve asked yet. I am getting ahead of myself. In fact, the Onc Doc, my Onc Doc as I now think of him, was drawing little circles, the results of my PET scan and bronchoscopy, on a ready made outline map of a human torso, skinned and boned to show the lungs and lymph nodes, so that I could see the smallness of the tumour (good) in the lower left lobe, but also that it was too close to the pleura to be operable (not so good), and how its somewhat active cells (rather bad) had already travelled along two lymph nodes up to a third beside my oesophagus (more than rather bad). With that careful insertion of ‘to treat, not to cure’ in his suggested plan of action, he had in effect just told me I was going to die in his care, sooner rather than later. Now I had to decide, do I want to ask that obvious next question? And the one after that? (How long, then, without treatment?) I believe he knew exactly how these appointments went. Why should I make it easy for him, I now thought? It’s quite hard to rapidly absorb the notion that someone forecasting your fairly imminent death might not be your enemy. More than that, the great weariness combined with the previously mentioned embarrassment, at the idea of asking question B or 2 and thereby setting the expected ball of clichés rolling, was overwhelming. Instead of complying, I imagined I could instead nod a thank-you and take my leave of the doctor and the nurse. The Poet would leave with me, and we’d never mention it again. The Woman with No Name approach. A short shriek of Morricone, after the door has closed behind us. But that wouldn’t do, either. After the heroic moment there would be the hour-by-hour living. Everyday life, even a shortened one, doesn’t permit heroic blankness in the way film does. Say, Leone’s long, long close-up of Eastwood’s or Fonda’s impassive face; the Warhol movie of John Giorno sleeping for five hours and 20 minutes; Jarman’s 79-minute single shot of saturated blue.

Or I could do nothing. I could sit in sadistic silence waiting for whatever is next on his list of diagnostic appointment moves for all occasions.

‘Yes? And?’

Sullen rudeness is a possible option handed to us cancerees. It would institute a period of bad behaviour as one’s own private glumly gleeful saturnalia, world turned upside down, lord of misrule regulated havoc, for a short period before the great slog of getting on with it began again, cancer or no cancer. I probably couldn’t sulk unto death, no matter that I’m one of the foremost sulkers on the planet. I’d get hungry. Or want to watch TV. Or even have an itch I had to scratch, and any such desire immediately and fatally cracks the implacable wall of sulk. Another route through the carefully tended maze of standard responses looks like the most spontaneous, although it really needs to be yelled by Jack Lemmon, tortoise-style, sticking his neck right out, inches from Onc Doc’s face. ‘You’re telling me I’ve got CANCER? That I’m going to DIE, because don’t think I don’t know that INOPERABLE means it’ll spread along the tracks from lymph node to nymph load (I’d apologise for that, but I’m not sorry). You’ve just said you reckon, with all your hedging and ditching, that I’m going to be DEAD IN THREE YEARS. If I’m LUCKY. Have I got that RIGHT?’

Actually, he said ‘two to three years’. (The weeks moment passed, leaving me less cheered than I ought to have been.) But I’ve taken the long view to stop any quibbling. I do wonder, now he’s laid the numbers out, with all the ifs and buts and maybes, how he manages his probability predictions. Does he pop an extra year on after ‘or’, for luck, like one for the pot? Or does he shift the lower end of the prediction a little towards the future to soften the felt brevity of a single year to someone whose time is slipping past at the speed of a 67-year-old’s perception. Perhaps he’s always as scrupulously accurate as possible in these situations, because, although he would like to offer a false glimmer of optimism which is said to be as good as a placebo, he doesn’t want to risk my ghostly or my next of kin’s litigious fury if I died a day short of his over-generous soonest prediction. So I should believe him because fear of a lawsuit makes doctors realistic and therefore trustworthy. This not crazily short but vague two-to-three-years is a difficult real-life calculation for me. On the one hand, to die pushing seventy years of age is no great tragedy, even if my id would like to know what the fuck age has got to do with being rubbed out. Even so, such reasonableness doesn’t take account of the kind of thoughts that run swiftly through my mind. Two to three years. Will the battery on the TV remote run out first? How many inches will the weeping birch grow, the one planted by the Poet for my sixtieth birthday (soppy old radical versifier)? I suppose I won’t need another cashmere sweater to keep me warm come the planet’s apocalypse, the ones I’ve already got will survive the moths for a couple of years or even three should it come sooner than my own apocalypse. I very much regret the disappearance of a website I once bookmarked called Sensible Units. It took a scientific unit of quantity and resolved it into units that are much more easily or entertainingly imagined. Who knew that 1 cm of depth is equivalent to 29 human female fingernail thicknesses? Or that 80 gigabytes can be visualised as 110 CDs or 25 human genomes?

So, when my Onc Doc announced that I had cancer, inoperable cancer, and that there was no cure, but some lengthy and famously unpleasant treatment that might get in the way of its speedy (the word ‘aggressive’ comes to mind but wasn’t actually said) progress, I chose the threadbare joke, from the already ready possible options. Because I had to choose something. But, as well as doing what I had to do in my new role, and for more than any other reason, it was a short-term panic-stricken solution for the flood of embarrassment, much more powerful than alarm or fear, that engulfed and mortified me at finding myself set firmly on that particular well-travelled road. I am and have always been embarrassed by all social rituals that require me to participate in a predetermined script. It may simply be that I am not a natural actor. That would account for the funk. Perhaps, having been handed this inescapable part, I was suffering from stage fright. It goes deep. I can perform at other people’s dinner tables like a chattering magpie, arguing and picking up on the conversation to make a joke or say something smart. Then I go home covered with a layer of self-disgust as if I’d been rolling in donkey shit, and for a day or two afterwards, I stay in bed with the covers over my head in shame. In public and prescribed ritual, I have no easy get-out, but I can’t just get on with it. The only way I can manage – gracelessly – is to keep my head down, my eyes low, dig my fingers hard into my palm, and move my mouth a little, like John Redwood singing the Welsh national anthem, while other people enjoy themselves intoning the required utterances. Ever since I was a child, it’s been like that.

‘You​ have to say, “I wish you long life,” and shake his hand,’ my father told me on our way to visit a relative sitting shiva. The rest of the journey was an agony of anticipation. I knew I couldn’t say those words. I wouldn’t be able to get them out. They were ridiculous, not what I’d really ever say to someone else. Not what small children would say and do, and it seems I could only play one role at a time. I’ve never been able to make my face work properly while repeating a set speech. Also, it seemed mean-spirited towards the newly dead to hope the mourner lived longer, who after all already had. ‘It’s what you do. Just say it and then go and get a smoked salmon bagel.’ I could almost see that the anguish of the occasion was not actually mine, but belonged to the bereaved. Still, I couldn’t bear to think about doing it. It wasn’t what I would say, therefore I couldn’t say it. I think also, it was expected of me, and therefore I couldn’t do it. I wonder what would have happened if I hadn’t been instructed. Would I have taken his hand and said something suitable? What could that be? I might just have said, as I would now, ‘I’m very sorry.’ Why wasn’t I allowed to do that? Because. We arrived and I took the hand offered me, but failed to look into his eyes, which, because of the low seating arrangement for chief mourners, were level with mine. I think I stared off to one side. And I managed only a mumbled noise, a strangled moan. Nothing that could be mistaken for ‘I wish you long life.’ I’d failed and although I knew I was in trouble, I was relieved not to have said the words out loud, while people watched me and smiled at the sweet little girl maintaining the grown-up tradition with archaic words translated from the Yiddish.

Growing up hasn’t helped. Marriage ceremonies have been as difficult, even though I was an adult. The first was a blur, although I remember the fingers digging into my palm, and handing over my gold opal ring to my betrothed, just before we went in to be ‘done’, so he could slip it on my finger with the opal at the back, because we hadn’t got round to even thinking about a ring until the morning of the registry office ceremony. Certainly, I was embarrassed and tied in knots by the corniness of the whole performance. Roger didn’t mind, he always enjoyed me disconcerting his parents. By the time of my second marriage, well into my dog days, I had enough confidence to ask the registrar who was to perform the ceremony if I could just say ‘Yes’ when it got to the bit where I was required to say ‘I do,’ and to miss out repeating the affirmations about better or worse, sickness and bla bla bla, already much minimised by me and the Poet. She looked at me as if I’d kicked her favourite bunny. ‘We are allowed to give people permission to do that,’ she said. ‘But only when they’re terminally ill and have difficulty speaking.’ I stopped myself from saying that I wasn’t feeling too perky, actually, and who knows what it might turn into. Properly shamed, I went through with it, sotto voce and choking back some but not all the nervous giggles that always rise up when I’m forced to participate in ritual. The Poet said I behaved childishly and I completely agreed. I decided I was definitely not going to do that again, no matter how practical it might be.

Now I was faced with the prospect of a rather lengthy (in one view) public/private performance by which to be excruciated. A sudden death requires others to deal with the difficulty of ritual. A stroke, a heart attack. Then it’s all someone else’s problem. But this diagnostic appointment was the announcement of yet another version of the show going on the road in which I was to star. I had been formally inducted into Cancer World. (Mixing my metaphors, I’m afraid. Which should it be, the theme park or the lack of variety show?) I was handed my script, though all the lines were known already and the moves were paced out. There are no novel responses possible. Absolutely none that I could think of. Responses to the diagnosis; the treatment and its side effects; the development of cancer symptoms; the pain and discomfort; the dying; the death. Do I have to start a campaign? Wear a badge, run, climb walls, swim inordinate lengths, dance the tango for a very long time, in return for money for cancer research? Whatever that is. Does the money go to the drug companies? To university labs? To Jeremy Hunt? What is this crowd-funded research, where is it happening? Am I going to appear calm in the face of destiny? Actually cheerful, with people saying I was wonderful? Should I affirm my atheism or collapse into religious comfort? Or should I turn my face to the wall? And when the symptoms kick in, will I suffer in silence, quote Epictetus and Marcus Aurelius, or will I refuse to go gentle and make an almighty fuss (‘Excuse me, I’m the cancer patient here!’). Dear God, not a bucket list? Really, there is nothing that I want to do before I die, except perhaps just lie back and enjoy the morphine, daydreaming my way to oblivion.

One thing I state as soon as we’re out of the door: ‘Under no circumstances is anyone to say that I lost a battle with cancer. Or that I bore it bravely. I am not fighting, losing, winning or bearing.’ I will not personify the cancer cells inside me in any form. I reject all metaphors of attack or enmity in the midst, and will have nothing whatever to do with any notion of desert, punishment, fairness or unfairness, or any kind of moral causality. But I sense that I can’t avoid the cancer clichés simply by rejecting them. Rejection is conditioned by and reinforces the existence of the thing I want to avoid. I choose how to respond and behave, but a choice between doing this or that, being this or that, really isn’t freedom of action, it’s just picking one’s way through an already drawn flow chart. They still sit there, to be taken or left, the flashing neon markers on the road that I would like to think isn’t there for me to be travelling down. I am appalled at the thought, suddenly, that someone at some point is going to tell me I am on a journey. I try but I can’t think of a single aspect of having cancer, start to finish, that isn’t an act in a pantomime in which my participation is guaranteed however I believe I choose to play each scene. I have been given this role. (There, see? Instant victim.) I have no choice but to perform and to be embarrassed to death. I wish you long life.

We’d hardly​ got home before I said: ‘Well, I suppose I’m going to write a cancer diary.’ The only other thing I might have said was: ‘Well, I’m not going to write a cancer diary.’ Right there: a choice? I’m a writer, have been since I was small, and have earned my living at it for thirty years. I write fiction and non-fiction, but it’s almost always personal. I start with me, and often enough end with me. I’ve never been apologetic about that, or had a sense that my writing is ‘confessional’. What else am I going to write about but how I know and don’t know the world? I may not make things up in fiction, or tell the truth in non-fiction, but documentary or invented, it’s always been me at the centre of the will to put descriptions out into the world. I lie like all writers but I use my truths as I know them in order to do so.

‘I wonder if I am not talking yet again about myself. Shall I be incapable, to the end, of lying on any other subject?’ I used this quote from Malone Dies as the epigraph to my non-fiction so-called travel book Skating to Antarctica, though it would have been apt, to my mind, at the front of any book I’ve written, fiction or non-fiction, memoir or travel, history or fantasy. Skating concerned a voyage I took around the Antarctic peninsula and the story of my rather brief, rackety relationship with my mother. ‘You know,’ I’d say gayly to people who asked what it was about. ‘Icebergs, mothers. That sort of thing.’ I couldn’t even describe the most extraordinary landscape on the planet without reference to myself and my life outside the Antarctic cruise. I can’t use my eyes to see things without my eyes knowing that what they see is conditioned by what I’ve known and what I’ve been. Ditto my mind to think things. So be it. I’m a writer. I’ve got cancer. Am I going to write about it? How am I not? I pretended for a moment that I might not, but knew I had to, because writing is what I do and now cancer is what I do, too.

And then the weariness. A fucking cancer diary? Another fucking cancer diary. I think back to cancer diaries I have read, just because they’re there. You don’t seek cancer diaries out, they come at you as you turn the pages of magazines and newspapers or thumb through Twitter and blogs. How many have I read? I can’t remember, but they’ve spanned decades. I recall Ruth Picardie, a young woman in her thirties, with small children. John Diamond, married to Nigella Lawson and dying stylishly. Ivan Noble, a BBC science and technology writer; Tom Lubbock, art critic; Susan Sontag, although not exactly a diary, mined her cancer for a famous essay about the cultural nature of illness. Those stood out, they were all professional writers and most wrote their diaries as occasional or regular series for newspapers or online blogs. Can there possibly be anything new to add? Isn’t the cliché of writing a cancer diary going to be compounded by the impossibility of writing in it anything other than what has already been written, over and over? Same story, same ending. Weariness. The odd thing is, narcissistic writer though I am, I have always thought of writing straight autobiography as incredibly tedious. I couldn’t put hand to keyboard without there being something else, some other component in the narrative than just my personal history. In 1984, while I was in a deep and long depression, largely, I think, about how I wasn’t being a writer, my previously adoptive or foster mother, Doris Lessing, would say, in her matter of fact, impatient way: ‘Well, just write down your life story. It’s interesting enough, and there are editors who can deal with sorting out your sentences and that kind of thing.’ She wafted her arm in the air to show me how easy it would be. It was intended to encourage me. It made me even more silent with despair. I wasn’t interested in just being published. I wasn’t even interested in writing something ‘interesting enough’. I was a writer and I couldn’t understand why I wasn’t writing. The answer was, I think, that I hadn’t understood how writing gathers everything into itself to make a satisfactory piece. My story, someone else’s story, a place, an idea, a dream, human anatomy, the mind acting on the world, vice versa, some or all and more yet unthought of, had to be combined in the right amounts in order to make a book, an essay, fiction, non-fiction, history, comedy, whatever, work. I was enough of a writer to know that writing the story of my interesting childhood was not being a writer. I was enough of a writer to be dismayed that Doris, having known me by then for nearly two decades, didn’t know that about me. I was also, in spite of my depression, quite insulted that she thought my sentences needed such tending.

In my experience, writing doesn’t get easier the more you do it. But there is a growth of confidence, not much, but a nugget, like a pearl, like a tumour. You learn that there is a process, and that it doesn’t very much matter what you write, but how you do it, that is crucial, and that nothing I wrote, or you wrote, is ever going to be the same as what she wrote and he wrote, unless, as Truman Capote said, what you’re dealing with isn’t writing, but typing. So I’ve got cancer. I’m writing.

You can read the next instalment of Jenny Diski's memoir here.